Dr Falk Pharma UK announces the UK launch of Jorveza, the first globally licensed drug approved for the treatment of the immune mediated, chronic and progressive disease of the oesophagus, Eosinophilic Oesophagitis (EoE).
Jorveza is an orodispersable tablet containing the topical corticosteroid budesonide and is specifically designed to deliver directly to the inflammation within the oesophageal mucosa.
In a randomised, controlled clinical trial, Jorveza demonstrated high rates of clinical and histological remission and high patient tolerability, with few side effects. Its UK launch has been welcomed by clinicians and patient groups as a significant step forward for those living with this debilitating and unpleasant condition.
EoE is clinically characterised by oesophageal dysfunction and histologically characterised by an eosinophil-rich inflammation, most probably caused by common food allergies or other environmental triggers. Often misdiagnosed as GORD (gastro oesophageal reflux disease), adult symptoms include dysphagia, bolus obstruction and chest pain related to swallowing, heartburn and regurgitation.
In children they can include reflux-related symptoms, nausea, vomiting, abdominal pain, refusal to eat or failure to grow. Untreated EoE can lead to oesophageal remodelling including the formation of strictures and EoE is the cause of more than 50% of all emergency presentations for oesophageal food bolus impactions.
Up until the UK launch of Jorveza, treatment for EoE has been focused around three areas; dietary exclusion, drugs and dilation. Dietary exclusion is generally considered hard to maintain and costly to follow up, whilst current steroid drug therapy delivery is not optimised for delivery to the oesophagus and relies on off-licence asthma medication. Dilation, carried out when the disease has progressed to oesophageal strictures, is an invasive procedure which only manages the symptoms but not the cause of EoE and often has to be repeated.
EoE is most frequently diagnosed in males aged 30-50 although it can be found in all age groups. Annual incidence rates of EoE in western countries are 1.7 per 100,000 with prevalence rates of 16.1 per 100,000. However, for patients with oesophageal symptoms who undergo gastroscopy the prevalence is 7% whilst in patients with dysphagia and bolus obstruction, prevalence increases to 23-50%. Many patients have a history of atopy, particularly asthma, allergic rhinitis and eczema.
EoE only received classification in the 1990s and disease awareness amongst both clinicians and the general public is thought to be low. Currently, average time to diagnosis is up to 8.1 years whilst a 2016 study found only 22% of patients reporting to A&E with food bolus and dysphagia were biopsied to confirm diagnosis of the condition.
Dr Riadh Jazrawi, Medical Director of Dr Falk Pharma UK said, ‘The UK launch of Jorveza represents an extremely positive development for those living with EoE. Not only does it provide innovative drug delivery targeted directly to the area of inflammation, Jorveza also has proven patient and disease efficacy outcomes compared to placebo. Further, it is easy to take, with few side effects, providing EoE patients and clinicians with a highly beneficial alternative to current DIY unlicensed treatments.’
Professor Stephen Attwood, Consultant Surgeon and Honorary Professor at Durham University, and one of the first doctors to identify and highlight the condition commented on the UK launch of Jorveza, he said, ‘EoE has a considerable impact on the quality of life and the self-esteem of patients. Not only do many develop adaptive eating strategies such as prolonged chewing, drinking copious amounts of liquids and avoiding certain foods, they also dread social situations and even eating with their families. Young adults can be labelled as having psychological eating disorders whilst young children often fail to thrive and can suffer from malnutrition.
‘Therefore, it is vital that there is greater general awareness of the condition. A key message for clinicians has to be that any patient who presents with pain on eating or feeling that food is sticking in the throat – especially if they have a history of allergic illnesses such as rhinitis, asthma and eczema – should be referred for biopsies with a specific request to look for eosinophils. And, when diagnosed, a long-term topical steroid developed directly to the inflammation is the only treatment which has proven efficacy and lasting outcomes.’
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