Allergy, Asthma CE/CME ACCREDITED Watch Time: 37 mins

touchPANEL DISCUSSION The practicalities of eosinophilic oesophagitis management: A closer look at emerging biologic treatment options

Watch leading experts discuss practical aspects of caring for children and adults with EoE, drawing on their own clinical experiences.

Dr Nirmala Gonsalves

Northwestern University Feinberg School of Medicine, Chicago, IL, USA

CHAIR

Panelists:
Dr Sharon Hall, Dr Salvatore Oliva
 
Video Chapters
Introduction

Dr Gonsalves introduces the faculty and discussion topics for this activity.

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1/4 Next Chapter
 
EoE in children and adults: What are the similarities and differences?

The expert panel discuss the latest understanding of EoE pathophysiology and how this manifests clinically in both children and adults.

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Caring for children with EoE: How can we manage the transition to adult services?

The expert faculty review the transition of care pathway for patients with EoE who are moving from paediatric to adult services, including insights from their own clinical experiences.

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Treating children and adults with EoE: What do the latest data show?

The expert panel review current treatment options for patients with EoE in accordance with the latest guidelines and the potential role of biologic therapies in clinical development.

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Learning Objectives & Overview
Overview

In this activity, international experts discuss the similarities and differences in the clinical presentation of children vs adults with eosinophilic oesophagitis (EoE), the transition of care from paediatric to adult services, and the current and future treatment options for patients with EoE.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of adult and paediatric gastroenterologists, adult and paediatric allergists/immunologists, paediatricians, advanced nurse practitioners, physician assistants and practice nurses involved in the management of patients with eosinophilic oesophagitis.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Dr Nirmala Gonsalves discloses: Advisory board/panel fees from Allakos Inc. Consultancy fees from AstraZeneca, AbbVie, Knopp Biosciences, Nutricia, Sanofi/Regeneron Pharmaceuticals, Inc. Speaker’s bureau fees from Takeda (Relationship Terminated).

Dr Sharon Hall has no relevant financial relationships with an ineligible company to disclose.

Dr Salvatore Oliva discloses: Advisory Board or Panel fees from Medtronic. Consultancy fees from Medtronic. Grant/research support from Medtronic and Alfasigma (relationship with Alfasigma terminated). Speaker’s bureau fee from Medtronic.

Content reviewer

John Jacobs, MD, Peer Reviewer has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Kathy Day and Anne Nunn have no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 19 July 2022. Date credits expire: 19 July 2023.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

Learning Objectives

After watching this activity, participants should be better able to:

  • Compare the pathophysiology and clinical manifestations of EoE between children and adults
  • Summarize how the transition of care is managed as children with EoE become adults
  • Evaluate the impact of the latest data for emerging biologic treatment options for EoE on clinical practice
Faculty & Disclosures
Dr Nirmala Gonsalves

Northwestern University Feinberg School of Medicine, Chicago, IL, USA

Dr Gonsalves is a professor of medicine in the Division of Gastroenterology & Hepatology and Northwestern University Feinberg School of Medicine, Chicago, IL, USA, and is Co-director of the Northwestern Eosinophilic Gastrointestinal Disorders Program. read more

Dr Gonsalves is a steering committee member of The International Gastrointestinal Eosinophil Researchers (TIGERS), a co-investigator for the National Institute of Health (NIH)-funded U54 Grant Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR, Principal Investigator [PI]-Rothenberg), and locally serves as the Director of the Northwestern Biorepository, one of the Cores of the NIH Program Project Grant (PI-Pandolfino) focused on disordered biomechanics in the oesophagus. 

Dr Gonsalves has been involved in research activities related to defining clinical metrics and dietary treatments, including consensus recommendations identifying the optimal number of biopsies needed during diagnostic eosinophilic oesophagitis (EoE)-related endoscopic procedures, quality of life metrics and an endoscopic scoring platform. Her most impactful article, featured on the cover of Gastroenterology, showed for the first time, the effectiveness of dietary elimination in adults with EoE. Most recently, she was the PI for the CEGIR sponsored ELEMENT (Elemental Diet in Eosinophilic Gastroenteritis Nutrition Trial) study, the first prospective dietary study in adults with eosinophilic gastritis/gastroenteritis (EG/EGE) that showed that food allergens were critical in the pathogenesis of these diseases. She has served as the Principal or Co-investigator for many of the pharmaceutical studies for EoE and non-EoE EGIDS at Northwestern, Memorial Hospital, IL, USA. As part of the CEGIR team, she has been heavily involved in the development of consensus guidelines for the diagnosis and management of EG/EGE. She has also been a medical advisor for patient advocacy groups in eosinophilic disorders and has worked on various education and disease awareness platforms for EGIDs.

Dr Nirmala Gonsalves discloses: Advisory board/panel fees from Allakos Inc. Consultancy fees from AstraZeneca, AbbVie, Knopp Biosciences, Nutricia, Sanofi/Regeneron Pharmaceuticals, Inc. Speaker’s bureau fees from Takeda (Relationship terminated).

Dr Sharon Hall

Imperial College Healthcare NHS Trust, London, UK

Dr Sharon Hall is a consultant in paediatric allergy at Imperial College Healthcare NHS Trust, London, UK, providing one of the largest paediatric joint allergy gastroenterology services in the UK. Her interests include gastrointestinal allergy, complex multisystem allergic disease, and integrated care. read more

Dr Hall leads the North and West London (NWL) Regional Allergy Network and continues to work with the NWL Asthma network and community and primary care providers to improve access and equity of access to asthma and allergy expertise. Dr Hall initially trained in general practice, then subsequently in general paediatrics with specialist interests in allergy and gastroenterology, having developed these services as a consultant in secondary care, before subspecializing in tertiary allergy care.

Dr Sharon Hall has no relevant financial relationships with an ineligible company to disclose.

Dr Salvatore Oliva

Sapienza University of Rome, Italy

Dr Oliva is a paediatric gastroenterologist working as an assistant professor of pediatrics at the Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Italy. read more

During the last 10 years, he has published over 113 manuscripts and 20 book chapters in international peer-reviewed journals indexed in Pubmed/Medline and/or Scopus/ISI, mainly in the fields of paediatrics, gastroenterology and gastrointestinal endoscopy. Dr Oliva has been invited to review papers for several journals. He participated in training and lecturing medical and master’s students at the Medical School of Sapienza University of Rome, Italy. He is a member of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and is currently involved in several working groups: Endoscopy Working Group, Eosinophilic Gastrointestinal Disorders (EGDIs) Working Group and in the IBD Interest Group.

Dr Oliva is currently co-ordinating the European Prospective Pediatric Registry of Eosinophilic Esophagitis (pEEr) and The Pediatric Eosinophilic Gastrointestinal Disorders Biobank (PEGID-BB) on behalf of ESPGHAN. He has been a visiting scientist at the Cincinnati Center for Eosinophilic Disorders, Cincinnati Children’s Hospital Medical Center, OH, USA, and he has been a member of the steering committee of the European Study Group of Eosinophilic Esophagitis (EUREOS) as a Paediatric Officer since 2020.

Dr Salvatore Oliva discloses: Advisory Board or Panel fees from Medtronic. Consultancy fees from Medtronic. Grant/research support from Medtronic and Alfasigma (relationship with Alfasigma terminated). Speaker’s bureau fee from Medtronic.

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Question 1/5
Which of the following clinical signs is more commonly seen in adults with EoE vs children with EoE?

EoE, eosinophilic oesophagitis.
Correct

EoE is a chronic disease that progresses from an inflammatory to a fibrostenotic phenotype. This may be why food impactions are more commonly seen in older adolescent and adult patients than in children.1 This is supported by data from a recent retrospective chart review of patients with EoE at a tertiary medical centre (n=41 children <21 years, n=136 adults >21 years), which showed that food impaction occurred significantly more frequently in adults vs children (31.0% vs 2.4%, p<0.001).2

Abbreviation

EoE, eosinophilic oesophagitis.

References

  1. Barni S, et al. Ital J Pediatr. 2021;47:230.
  2. Schuval S, et al. J Allergy Clin Immunol. 2021;147(Suppl. AB90):288.
Question 2/5
Your 4-year-old patient has recently been diagnosed with EoE. You discuss treatment options together with their parents but they are hesitant to initiate therapy. They ask if treatment can be delayed until their child is older, or if there is a chance they will “grow out of” EoE and therefore not require treatment. How would you advise them?

EoE, eosinophilic oesophagitis.
Correct

EoE is typically a chronic progressive disease driven by eosinophilic inflammation that leads to the development of fibrosis and complications such as food impaction.1 Prompt initiation and maintenance of treatment are advised to control underlying inflammation and clinical symptoms and to prevent disease progression, relapse and future clinical consequences.1-3

Abbreviation

EoE, eosinophilic oesophagitis.

References

  1. Barni S, et al. Ital J Pediatr. 2021;47:230.
  2. Dhar A, et al. Gut. 2022;0:1–29.
  3. Hirano I, Furuta GT. Gastroenterology. 2020;158:840–51.  
Question 3/5
Your 12-year-old patient with EoE presents to your clinic for follow-up with their parents. Over the last year, they have maintained clinical and histological remission with dietary therapy. Their care is currently being managed by the paediatric multidisciplinary team and their parents, but in future they will require a transition of care to adult services. What would you do?

EoE, eosinophilic oesophagitis.
Correct

Introduction of the transition of care process can be considered from late childhood/early adolescence (11–13 years of age), in accordance with each patient’s developmental stage. This gives patients time to slowly develop their disease-specific knowledge and self-management skills, allowing them to take increasing responsibility in their own care. Families/carers also have time to gradually reduce their responsibilities and support the patient’s independence in managing their care. An individualized transition-of-care plan, developed in collaboration with the patient and their parents/carers, is recommended to assist patients in self-managing their EoE.

Abbreviation

EoE, eosinophilic oesophagitis.

Reference

Roberts G, et al. Allergy. 2020;75:2734–52.

Question 4/5
Your 15-year-old patient with EoE is currently on maintenance therapy with swallowed topical corticosteroids following resolution of symptoms. As part of their transition-of-care plan, over the last 3 months they have been taking responsibility for their own medication administration. At a follow-up visit they report that they have had intermittent difficulty swallowing recently and have been forgetting to take some medication doses. As well as conducting an endoscopy, what else would you do?

EoE, eosinophilic oesophagitis.
Correct

For adolescents and young adults with EoE who struggle with adherence to therapy, mobile- and web-based applications, medication reminders, monitors or routines can be suggested to help improve adherence, symptom control and quality of life.

Abbreviation

EoE, eosinophilic oesophagitis.

Reference

Roberts G, et al. Allergy. 2020;75:2734–52.

Question 5/5
Several biologic agents targeting the underlying pathophysiology of EoE are currently in various stages of development. How might these agents impact future clinical practice if reported with positive results?

EoE, eosinophilic oesophagitis.
Correct

Several biologic agents currently being evaluated in clinical trials, including dupilumab, cendakimab, and benralizumab, target different key components of the EoE inflammatory pathway. As such, these compounds may offer the opportunity for precision medicine in patients with EoE.1 Dupilimab is currently the only biologic agent licensed for use in treating EoE (in USA, for patients with EoE aged 12 years and older, weighing at least 40 kg).2

Abbreviation

EoE, eosinophilic oesophagitis.

References

  1. Racca F, et al. Front Physiol. 2022;12:815842.
  2. FDA. Dupilumab highlights of prescribing information. Revised June 2022. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/761055s042lbl.pdf (Accessed 5 July 2022)
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