EsoCap AG's ESO-101, a novel drug delivery system, has shown promising results in treating eosinophilic esophagitis (EoE). The ACESO Phase II study, published in Alimentary Pharmacology & Therapeutics, demonstrated that ESO-101 is safe, well-tolerated, and improves both histologic and endoscopic outcomes in adults with active EoE. The randomized, placebo-controlled trial involved 43 participants across 14 centers in Europe, highlighting the potential of this new treatment approach for a condition with limited options.
ACESO Trial: Key Findings
The ACESO study met its primary endpoint, demonstrating a statistically significant reduction in the peak eosinophil count from baseline in histology samples. Specifically, the ESO-101 group showed a mean reduction of 49.1 eosinophils/hpf (p=0.0318). In contrast, 48% of patients treated with ESO-101 achieved <15 eosinophils/hpf, indicating notable histological remission (p=0.0028), while none of the patients in the placebo group reached this milestone. Furthermore, 44% of patients in the ESO-101 group achieved <6 eosinophils/hpf (p=0.0035).
Dr. Alfredo J. Lucendo, coordinating principal investigator of the ACESO trial from the Department of Gastroenterology, Hospital General de Tomelloso, Spain, emphasized the significance of these findings: "The detailed results of the ACESO trial provide robust evidence for the efficacy and safety of ESO-101, a novel drug delivery device for the long-lasting, targeted delivery of the anti-inflammatory corticosteroid mometasone furoate directly to the esophageal mucosa."
Safety and Tolerability
Importantly, ESO-101 demonstrated a highly favorable safety and tolerability profile. There were no reported cases of oral, oropharyngeal, or esophageal candidiasis, which are commonly associated with topical corticosteroid treatments. Compliance was also high, with 100% in the ESO-101 group and 93% in the placebo group, underscoring the user-friendliness of the ESO-101 drug-delivery system.
ESO-101: A Novel Drug Delivery System
ESO-101 utilizes EsoCap's unique drug delivery technology to achieve localized treatment of the esophageal lining. The system consists of a capsule with a rolled-up, thin mucoadhesive film containing the anti-inflammatory corticosteroid mometasone furoate. Upon swallowing, the film unrolls and adheres to the esophageal mucosa, where it dissolves, providing a contact time of approximately 15 minutes. This extended contact time is significantly longer than that of conventional oral dosage forms, such as orodispersible tablets.
Eosinophilic Esophagitis: An Unmet Need
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disease characterized by symptoms such as dysphagia, food impaction, heartburn, and vomiting. Histologically, it is marked by eosinophil-dominated inflammation. Current treatment options, including strict diets, off-label steroids, proton pump inhibitors, and oral budesonide formulations, often prove suboptimal for many patients. A monoclonal antibody targeting IL-4 and IL-13 has been approved for steroid-resistant patients. With an estimated 500,000 patients worldwide, the prevalence of EoE is over 6 in 10,000, highlighting the need for more effective and targeted therapies.
Future Implications
Isabelle Racamier, CEO of EsoCap, stated, "The positive outcome of the ACESO Phase II study with ESO-101 and the publication in a peer-reviewed journal are an important validation of our targeted, topical delivery platform, which has been designed to increase mucosal contact time and drug deposition in the esophagus." These results suggest that ESO-101 could offer a significant advancement in the management of EoE, providing a more effective and safer treatment option for patients.
