Improving Access and Addressing Gaps in Guidelines and Emerging Therapies

Access challenges for EoE therapies encompass practical patient considerations and systemic barriers. Patient-level obstacles include tolerability concerns such as injection anxiety with biologics, adherence difficulties with twice-daily medications, and family dynamics around dietary restrictions that can create household discord. Systemic barriers involve insurance coverage variability, prior authorization requirements, and complex approval processes that differ significantly between insurers. Provider advocacy and persistence become crucial in navigating these challenges, requiring education about available resources and sustained effort to secure appropriate treatments for patients.

Significant knowledge gaps persist in this relatively young disease entity, with many practicing physicians lacking formal EoE education. Research priorities include developing biomarkers for disease monitoring, creating reliable tests to predict food triggers for dietary therapy, understanding disease severity progression patterns, and determining optimal treatment sequencing. The field needs comparative effectiveness studies between available therapies and personalized treatment approaches based on individual disease characteristics. Only 2 FDA-approved medications exist, both approved within the last 3 to 4 years, highlighting the nascent state of evidence-based treatment options.

Emerging therapeutic developments offer promising advances in multiple domains. New topical steroid formulations such as effervescent and fluticasone preparations aim to improve drug delivery to the esophagus. Additional biologics targeting type 2 inflammatory pathways, including benralizumab, and small molecule inhibitors such as TSLP inhibitors are in development. Beyond pharmacological advances, innovative monitoring approaches include transnasal endoscopy for unsedated procedures, particularly beneficial in pediatric populations, and esophageal string tests that could reduce reliance on full endoscopic evaluations. The field emphasizes developing monitoring strategies that are less burdensome than the disease itself. This exciting therapeutic landscape requires maintaining close patient relationships to capitalize on emerging options, while fostering clinician-patient partnerships that are essential for managing this chronic condition requiring long-term treatment adherence and lifestyle modifications.