Could Immunotherapy (EPIT) Work For Eosinophilic Esophagitis? & Coronavirus Up-to-Date Tally

A recent double-blind pilot study (n=20) (JM Spegel et al. Clin Gastroenterol Hepatol 2020; 18: 328-36) explored the use of epicutaneous immunotherapy (EPIT) in children with milk-induced eosinophilic esophagitis (EoE). 15 children received active treatment with a “Viaskin” milk allergen extract patch and 5 children received a placebo.

The premise of EPIT for EoE has been based on animal models (mouse & piglet) which have shown that epicutaneous desensitization to peanuts has been successful in preventing development of EoE.

The design of the study involved EPIT during a 9 month milk-free period followed by a milk-containing diet for 2 months.  Biopsies were taken and then there was an additional 11 month open-label phase in which all patients received EPIT.

Key findings:

  • No significant differences in mean eos/hpf in the two groups: 50 vs 48 in EPIT compared to placebo respectively.
  • There were 9 of 19 (47%) had a significant drop in eosinophil count with less than 15 eos/hpf at the end of the open-label phase.
  • Overall, adverse events were similar in both groups, though the EPIT group had more frequent GI adverse events than the placebo group (67% vs. 40%)

My take: The primary and secondary endpoints were not reached in this study.  However, based on the open-label phase response, further studies are warranted.

Related blog posts:

Also, from Johns Hopkins: COVID19 Caseload & Outcomes Worldwide

This screenshot was taken at 2:53 pm on 3/7/20