Eosinophilic Esophagitis (U.S.), October 2022
The MarketVue®: Eosinophilic Esophagitis market landscape report combines primary (KOL interviews and survey data) and secondary market research to empower strategic decision-making and provide a complete view of the market.
Every MarketVue® includes a disease overview, epidemiology (US and EU5), current treatment, unmet needs, pipeline and access and reimbursement chapter.
Topics covered in this report:
- Disease overview: Review the disease pathophysiology and potential druggable targets
- Epidemiology: Understand prevalence, diagnosed and drug-treated prevalence of the population and key market segments
- Current treatment: Understand the treatment decision tree and strengths and weaknesses of current on-label and off-label treatment
- Unmet needs: Identify opportunities to address treatment or disease management gaps
- Pipeline analysis: Compare current and emerging therapy clinical development strategy; their performance on efficacy, safety, and delivery metrics; and their potential to address unmet needs
- Value and access: Gain insights into the drug pricing landscape and payer controls within the disease market or analogous markets
Methodology:
Research for the MarketVue®: Eosinophilic Esophagitis report is supported by 4 qualitative interviews with key opinion leaders, a quantitative survey with 25 U.S. physicians and secondary research.
Geographies covered:
United States plus epidemiology for EU5 (France, Germany, Italy, Spain, United Kingdom)
Key companies mentioned:
- Regeneron Pharmaceuticals
- Sanofi
- AstraZeneca
- Bristol-Myers Squibb
- Ellodi Pharmaceuticals
- EsoCap
- Pfizer
- Dr. Falk Pharma
- Revolo Biotherapeutics
- Amzell Pharma
- EMS
Key drugs mentioned:
- Corticosteroids
- Dupilumab (Dupixent)
- Benralizumab (Fasenra)
- Tezepelumab (Tezspire)
- Etrasimod (Velsipity)
- Cendakimab / CC-93538
- APT-1011 / fluticasone propionate
- ESO-101 / mometasone
- Mesalazine
- IRL201104
- Budesonide
- Florence
Key takeaways from the report:
Despite being recognized as a distinct etiology of eosinophilic gastrointestinal disease for less than 30 years, EoE care has evolved to include four treatment options:
- Dietary therapy
- Proton pump inhibitors
- Corticosteroids
- Biologic therapy (Dupixent)
While EoE is marked by the availability of multiple drug classes, findings from REACH’s MarketVue® assessment of the EoE market show that nearly one-third of EoE patients would be eligible for treatment with novel drug classes like Dupixent, according to surveyed gastroenterologists.
Physicians are eager for more diverse EoE treatment options including FDA-approved corticosteroids and new therapies that can improve histologic and symptomatic response. Importantly, EoE patients play an outsized role in treatment selection.
Melissa Curran, Director at REACH: “With few prognostic markers to guide treatment recommendations, treatment selection is primarily patient driven. Physicians usually present all classes of treatments to patients and educate on the pros and cons of each option. Since many EoE patients are young and active, convenience is a key driver of treatment preference.”
The EoE pipeline is ripe with novel treatment options including:
- Ellodi Pharma’s reformulated corticosteroid APT-1011
- Bristol Myer Squibb’s IL-13 cendakimab
- Pfizer’s S1P etrasimod
Despite the flurry of development activity, late-stage failure is common in EoE (e.g., Takeda’s TAK-721, AstraZeneca’s Fasenra (benralizumab), Allakos’ lirentelimab) due to the frequent discord between histological and symptomatic response as one gastroenterologist comments: “I’m a big believer in the histology and what we’ve seen in trials is that symptoms don’t always correlate with histologic remission.”
1. DISEASE OVERVIEW
A chronic, inflammatory disorder of the immune system in the esophagus, characterized by dysphagia, food impaction, and regurgitation
Figure 1.1. Pathophysiology of EoE
EoE is the most common form of EGID
Figure 1.2. Classification of EoE
Table 1.1 EoE and GERD are not mutually exclusive and can co-occur but have their own distinguishing features
2. EPIDEMIOLOGY & PATIENT POPULATIONS
Disease definition
Figure 2.1 – G6 diagnosed prevalent cases of EoE by region
Table 2.1 – Diagnosed prevalent and drug-treated patients in the G6
3. DIAGNOSIS AND CURRENT TREATMENT
Diagnosis overview
Figure 3.1. Diagnostic pathway for EoE patients
Figure 3.2. Gastroenterologist-Reported Misdiagnosis and Delayed Diagnosis Among EoE Patients
Dietary therapy, PPIs and corticosteroids are the current standards of care
Treatment overview
Figure 3.3. Treatment goals for EoE
Figure 3.4. Current Treatment Patient Share
Treatment flow for EoE
Figure 3.5. Treatment algorithm for EoE
Physicians are satisfied with the efficacy of current treatments for EoE
Figure 3.6. Gastroenterologist rating (n=25) of current therapy effectiveness in EoE
Figure 3.7. Gastroenterologist-reported percentage of EoE patients who are refractory to current pharmacologic treatment options
Existing treatments work well but convenience could be improved for chronic use
Gastroenterologists’ opinions on current treatments
Dupilumab is the first and only FDA-approved drug for EoE
Figure 3.8. Phase 3 results for Regeneron/Sanofi’s dupilumab in EoE
Dupilumab is viewed favorably by physicians
Figure 3.9. Dupixent’s advantages observed in clinical practice
Figure 3.10. Treatment dynamics observed in clinical practice
Key treatment dynamics that shape disease management and drug use in EoE
Table 3.1 Must-know EoE treatment dynamics
Figure 3.11. Percentage of drug-treated patients surveyed gastroenterologist estimate would be eligible for novel classes of EoE therapy
The EoE market may see significant shifts over the next decade
Figure 3.12. Important dynamics of EoE market evolution
4. UNMET NEED
Overview
Figure 4.1 – Top unmet needs in EoE
Figure 4.2 – Physician-reported unmet needs in EoE
Two groups of EoE patients exist whose needs can be met by novel therapeutics
Figure 4.3 – High need patient types in EoE
Figure 4.4. Percentage of gastroenterologists who see this as a barrier to receiving drug therapay
The need for new EoE treatments is moderate compared to other Gi/allergic conditions
Figure 4.5 – U.S. gastroenterologists rating of the need for new treatments in gastrointestinal and allergic conditions
5. PIPELINE ANALYSIS
Overview
Figure 5.1. Number of emerging therapies addressing unmet needs in EoE
Pipeline for EoE has many late-phase products primed for launch
Table 5.1. Comparison of ongoing trials in EoE
The earlier phase pipeline for EoE is not as active as the late-phase pipeline
Table 5.1. Comparison of ongoing trials in EoE (continued)
Late-phase pipeline
Figure 5.2. Percentage of gastroenterologists who rated the following emerging therapies as “promising”
6. VALUE & ACCESS
Overview
Table 6.1 – Current therapy pricing
Table 6.2 – Typical commercial payer coverage of Rituxan and Dupixent (e.g., United Healthcare, Aetna, BlueCross BlueShield, Cigna)
Key market access dynamics that will continue to shape treatment use
Figure 6.1. – EoE patients by insurance type
Figure 6.2. – Gastroenterologist-reported key barriers to drug therapy for EoE patients
Figure 6.3. Dupixent montjly copay payments of Medicare and commercially-insured patients
7. METHODOLOGY
Primary market research approach
Epidemiology methodology
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By deploying our senior team to each of our reports, we can begin insight generation on day 1. The REACH team also recruits Key Opinion Leaders from our internal panel rather than outsourcing recruitment which enables us to quickly begin primary market research interviews.
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Does REACH cover both rare and non-rare diseases?
REACH specializes in covering diseases and subpopulations that are not addressed by traditional market research reports. As such, we focus on rare diseases and niche subpopulations of more common conditions (e.g., Dupixent-refractory atopic dermatitis). Our flexible model enables in-depth assessments across all disease types, allowing us to support research for non-rare conditions as well.
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