A Study Assessing Esophageal Function and Remodeling With Dupilumab Compared With Placebo for 24 Weeks Followed by 104 Weeks Open Label in Adult Participants With EoE (REMOdeling With Dupilumab in Eosinophilic Esophagitis Long-term Trial)

Study Overview
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Brief Summary
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This is parallel, Phase 4 study which consists of a 24 week (0.5 years) randomized, double blind, placebo controlled, 2-arm treatment period followed by an open label segment of 104 weeks (2 years) for a total of 128 weeks (2.5 years) to evaluate the effect of dupilumab treatment on esophageal function, and remodeling in adults with eosinophilic esophagitis. Duration of study period (per participant) Screening period: Up to 12 weeks before Week 0 Randomized double-blind period: 24 weeks Open label period: 104 weeks Post Investigational Medicinal Product (IMP) intervention follow-up period: up to 12 weeks or until the participants switch to commercialized dupilumab, whatever comes first. There will be ten (10) site visits, and five (5) direct-to-participant IMP delivery visits (except if prohibited by local regulatory authorities or if participant is not willing. In this case, IMP will be dispensed at the study site).

Detailed Description
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The duration per participant will be up to 152 weeks.

Official Title
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A Phase 4, Randomized, Multicenter, Double-blind, Parallel-group, 24 Weeks, Placebo-controlled Study Followed by 104 Weeks Open-label to Assess Dupilumab Efficacy on Esophageal Function and Remodeling in Adult Participants With Eosinophilic Esophagitis (EoE)

Conditions
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Eosinophilic Oesophagitis

Intervention / Treatment
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* Drug: Dupilumab
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: A documented diagnosis of EoE by endoscopic biopsy. Baseline endoscopic biopsies with a demonstration on central reading of intraepithelial eosinophilic infiltration. History (by participant report) of an average of at least 2 episodes of dysphagia (with intake of solids) per week in the 4 weeks prior to screening. Body weight ≥40 kg. Exclusion Criteria: Participants are excluded from the study if any of the following criteria apply: Other causes of esophageal eosinophilia or the following conditions: hypereosinophilic syndrome or eosinophilic granulomatosis with polyangiitis (Churg Strauss syndrome). Active Helicobacter pylori infection. History of achalasia, Crohn's disease, ulcerative colitis, celiac disease, and prior esophageal surgery. Any esophageal stricture unable to be passed with a standard, diagnostic, 9 to10 mm upper endoscope or any critical esophageal stricture that requires dilation at screening. History of bleeding disorders or esophageal varices. Treatment with swallowed topical corticosteroids within 8 weeks prior to baseline. Initiation or change of a food elimination diet regimen or reintroduction of a previously eliminated food group in the 6 weeks prior to screening. Participation in prior dupilumab clinical study or participants currently treated or have been treated with commercially available dupilumab or contraindicated to dupilumab per local labelling. The above information is not intended to contain all considerations relevant to a potential participation in a clinical trial

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Dupilumab<br>Subcutaneous injection (SC) as per protocol | Drug: Dupilumab<br>* Subcutaneous injection (SC) as per protocol<br>|
| Placebo Comparator: Placebo<br>SC injection as per protocol | Drug: Placebo<br>* SC injection as per protocol<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in esophageal distensibility plateau as measured by Functional Lumen Imaging Probe (EndoFLIP) | Distensibility plateau provides an assessment of esophageal function. An increase in distensibility plateau indicates an improvement in esophageal function and a decrease in distensibility plateau indicates a worsening of esophageal function. | From baseline to Week 24 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent change from baseline in esophageal distensibility plateau as measured by Functional Lumen Imaging Probe | Distensibility plateau provides an assessment of esophageal function. An increase in distensibility plateau indicates an improvement in esophageal function and a decrease in distensibility plateau indicates a worsening of esophageal function. | From baseline up to Week 24 | 
| Absolute change from baseline in esophageal distensibility plateau as measured by Functional Lumen Imaging Probe | Distensibility plateau provides an assessment of esophageal function. An increase in distensibility plateau indicates an improvement in esophageal function and a decrease in distensibility plateau indicates a worsening of esophageal function. | From baseline up to Week128 | 
| Percent change from baseline in esophageal distensibility plateau as measured by Functional Lumen Imaging Probe | Distensibility plateau provides an assessment of esophageal function. An increase in distensibility plateau indicates an improvement in esophageal function and a decrease in distensibility plateau indicates a worsening of esophageal function. | From Baseline up to Week 128 | 
| Change from baseline in eosinophilic esophagitis-endoscopic reference score (EoE-EREFS) | EoE-EREFS, a scoring system for inflammatory and remodeling features of disease. The overall total score ranges from 0 to 18 with higher number indicating worse disease. | From baseline up to Week 128 | 
| Change from baseline in eosinophilic esophagitis (EoE-HSS) Grade | Severity (grade) and extent (stage) of esophageal abnormalities are scored using a 4-point scale (0 normal; 3 maximum change). Higher score indicates greater severity and extent of histological abnormalities. | From Baseline up to Week 128 | 
| Change from baseline in EoE-HSS Stage | Severity (grade) and extent (stage) of esophageal abnormalities are scored using a 4-point scale (0 normal; 3 maximum change). Higher score indicates greater severity and extent of histological abnormalities. | From Baseline up to Week 128 | 
| Proportion of participants who achieved peak Esophageal Intraepithelial Eosinophil Count of ≤6 eosinophils/high power field (Eos/HPF) | Esophageal intraepithelial eosinophil count obtained by esophageal endoscopy with biopsies (all 3 esophageal regions: proximal, mid, and distal). | At Weeks 24, 76 and 128 | 
| Proportion of participants who achieved peak Esophageal Intraepithelial Eosinophil Count of ≤15 Eos/HPF | Esophageal intraepithelial eosinophil count obtained by esophageal endoscopy with biopsies (all 3 esophageal regions: proximal, mid, and distal). | At Weeks 24, 76 and 128 | 
| Change from baseline in normalized enrichment score (NES) for EoE diagnostic panel (EDP) transcriptome signature | NES reflects the degree to which the activity level of a set of disease transcripts is overrepresented at the extremes (top or bottom) of the entire ranked list of transcripts within a sample and is normalized by accounting for the number of transcripts in the set. An NES of 0 indicates no change from baseline, a negative score reflects a reduction in the disease score (more like normal) and a positive score reflects worsening (more active disease). | From baseline up to Week 128 (EOT) | 
| Change from baseline in normalized enrichment score (NES) for type 2 inflammation transcriptome signature | NES reflects the degree to which the activity level of a set of disease transcripts is overrepresented at the extremes (top or bottom) of the entire ranked list of transcripts within a sample and is normalized by accounting for the number of transcripts in the set. An NES of 0 indicates no change from baseline, a negative score reflects a reduction in the disease score (more like normal) and a positive score reflects worsening (more active disease). | From Baseline up to Week 128 (EOT) | 
| Incidence of treatment-emergent adverse events (TEAEs), and serious adverse events (SAEs) |  | From the first IMP administration up to end of post treatment follow up period (week139) | 
| Incidence of adverse events of special interest (AESIs) |  | From the first IMP administration up to end of post treatment follow up period (week139) |