{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T02:56:24Z","timestamp":1789440984986,"version":"build-2803163510"},"reference-count":172,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Eosinophilic esophagitis (EoE) has emerged as a major cause of dysphagia and food impaction worldwide. This narrative review traces the evolving therapeutic pipeline for EoE, highlighting agents spanning from late-stage clinical development to final approval. We summarize mechanistic insights that have driven a shift from broad immunosuppression to precise inhibition of type-2 inflammatory pathways, including blockade of key interleukin pathways. Randomized trials have demonstrated histologic and symptomatic gains, yet regulatory approvals and optimal positioning within treatment algorithms are pending. Parallel innovations in drug delivery aim to maximize mucosal exposure while minimizing systemic burden. Key challenges include heterogeneity in disease phenotype, paucity of long-term safety data, and the need for non-invasive biomarkers to guide precision prescribing. Cost considerations and patient preferences will shape adoption. By integrating advances across immunology, formulation science and clinical trial design, the therapeutic pipeline for EoE holds promise to transform care from empirical suppression to mechanism-based disease modification.<\/jats:p>","DOI":"10.3390\/ph18121882","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T12:52:31Z","timestamp":1765543951000},"page":"1882","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Therapeutic Pipeline for Eosinophilic Esophagitis: Current Landscape and Future Directions"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1791-4506","authenticated-orcid":false,"given":"Andrea","family":"Pasta","sequence":"first","affiliation":[{"name":"Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9816-4171","authenticated-orcid":false,"given":"Luisa","family":"Bertin","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy"},{"name":"Gastroenterology Unit, Azienda Ospedale Universit\u00e0 di Padova, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Mari","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Nazareth EMMS Hospital, Nazareth 16100, Israel"},{"name":"The Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan 15208, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4706-1499","authenticated-orcid":false,"given":"Francesco","family":"Calabrese","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy"},{"name":"IRCCS Policlinic San Martino Hospital, Viale Benedetto XV, 6, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3522-7292","authenticated-orcid":false,"given":"Amir","family":"Farah","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Navazzotti","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy"},{"name":"IRCCS Policlinic San Martino Hospital, Viale Benedetto XV, 6, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6026-5639","authenticated-orcid":false,"given":"Matteo","family":"Ghisa","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy"},{"name":"Gastroenterology Unit, Azienda Ospedale Universit\u00e0 di Padova, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6803-1952","authenticated-orcid":false,"given":"Vincenzo","family":"Savarino","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3187-2894","authenticated-orcid":false,"given":"Edoardo Vincenzo","family":"Savarino","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy"},{"name":"Gastroenterology Unit, Azienda Ospedale Universit\u00e0 di Padova, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8526-837X","authenticated-orcid":false,"given":"Edoardo Giovanni","family":"Giannini","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy"},{"name":"IRCCS Policlinic San Martino Hospital, Viale Benedetto XV, 6, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4507-8605","authenticated-orcid":false,"given":"Elisa","family":"Marabotto","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy"},{"name":"IRCCS Policlinic San Martino Hospital, Viale Benedetto XV, 6, 16132 Genoa, 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