Testing Effectiveness of Losartan vs Placebo in Patients With EoE With or Without a CTD

• Number of participants with reduction of esophageal eosinophils [ Time Frame: up to five years ] [ Designated as safety issue: No ]

  Tissue samples will be obtained from the esophagus from participants to determine the effects of losartan compared to placebo on the reduction of esophageal eosinophils in participants with eosinophilic esophagitis with or without a connective tissue disorder. It is planned to evaluate the reduction as follows:

  1. % of participants with reduction of eosinophil count to 0 in placebo versus losartan treated
  2. % of participants with reduction of eosinophil count to less than 15 in placebo versus losartan treated
  3. Average reduction in eosinophil count in placebo versus losartan treated
  4. Comparison across groups with and without a connective tissue disorder
  
  

• Number of participants with reduction in levels of the transforming growth factor beta protein. [ Time Frame: up to five years ] [ Designated as safety issue: No ]
  Blood and tissue samples will be obtained from participants throughout the study to evaluate losartan versus a placebo on the reduction in levels of transforming growth factor beta (TGF-β pg/mL) in the blood and esophagus. Comparisons will be made between the placebo and losartan treated groups.
  
  
• Number of participants that experience normalization of the EoE transcriptome [ Time Frame: up to five years ] [ Designated as safety issue: No ]
  Blood and tissue samples will be obtained throughout the trial to investigate the number of participants that experience a normalization of the EoE transcriptome, mRNA expression fold difference <2 compared to normal controls in participants with EoE with or without a connective tissue disorder
  
  
• Number of participants that have an improved score utilizing the Patient Reported Outcome questionnaires to assess for clinical symptom response. [ Time Frame: up to five years ] [ Designated as safety issue: No ]
  To evaluate the effect of losartan versus a placebo by utilizing the Patient Reported Outcome questionnaires (metric scoring algorithm) to assess for clinical symptom response. Comparisons will be made between the placebo and losartan treated groups.
  
  
• Number of participants that have an improved score on the histology scoring system. [ Time Frame: up to five years ] [ Designated as safety issue: No ]
  To evaluate the effect of losartan versus placebo by a study staff member pathologist scoring the tissue samples by utilizing the histology scoring system. This scoring system was created to express the severity and extent of abnormalities in the gastrointestinal tract that often accompany eosinophilic inflammation. Comparisons will be made between the placebo and losartan treated groups.
  
  
• To determine the safety of Losartan versus placebo [ Time Frame: up to five years ] [ Designated as safety issue: Yes ]
  To determine the safety of losartan versus placebo by the absences of adverse events will be recorded in participants with Eosinophilic Esophagitis with or without a connective tissue disorder.
  
  

Losartan is a drug that is approved by the United States Food and Drug Administration (FDA) for use in adults and children over 6 years of age who have high blood pressure. Losartan has been safe when administered to patients with normal blood pressure. This medication has not been studied in people with eosinophilic esophagitis or connective tissue disorder. Eosinophils are a type of white blood cell that induces inflammation. Eosinophils with other inflammatory cells produce a protein called TGF-β, which may contribute to part of EoE. Losartan may reduce the amount of this protein and therefore, be a treatment for eosinophilic esophagitis.

You will be in the research study for approximately 6 months. Participation in this research study will involve 12 study visits. Of the 12 study visits, at least 6 visits will take place in the clinic; the other visits may take place over the telephone.

Throughout the study, the following activities will occur:

1. A physical and vital signs will be obtained
2. There will be two endoscopies performed one at the beginning and one at the end of the study
3. Blood will be obtained up to three times
4. Pregnancy tests will be performed
5. Quality-of-life questionnaires will be completed

This is a double-blind study, which means neither you nor the researchers conducting this study will know what treatment group you are in. However, in the event of an emergency, your study doctor will be able to find out which treatment you are receiving. You will start the study drug at a low dose. It will be increased over time (over a period of 3 months at study Visit 2/Week 0, Visit 3/Week 4, and Visit 4/Week 8). The dose of study drug will be increased depending on your weight and how well you tolerate each dose but will not exceed 100mg of study drug per day. It may be increased or decreased during the study if there are any side effects. If you do not have certain side effects, you will take each dose of the study drug between 21 and 28 days until your next study visit. You will swallow a pill or liquid once or twice a day.

This study will consist of 4 phases: screening, treatment (titration and maintenance), end of treatment, and follow-up. Participants that are between 5 to 18 years of age, as well as the parent or legal guardian will be asked to complete questionnaires of quality-of-life symptom severity questionnaires. If you are the parent or caretaker, the only study activity in which you will be involved is the completion of questionnaires about you and your family.