Esophagus to Small Intestine
Clin Gastroenterol Hepatol. 2024;22(2):252–8
Real-world efficacy of dupilumab in severe, treatment-refractory, and fibrostenotic patients with eosinophilic esophagitis
Background and aims: Dupilumab is approved for treatment of eosinophilic esophagitis (EoE), but real-world data are lacking. The authors aimed to determine the real-world efficacy of dupilumab in patients with severe, treatment-refractory, and fibrostenotic EoE.
Methods: They conducted a retrospective cohort study of EoE patients prescribed dupilumab and who were treatment-refractory to standard modalities. Patient demographics, clinical characteristics, EoE history, and procedural data (including the histologically worst, predupilumab, and postdupilumab endoscopies) were extracted from medical records. Symptomatic, endoscopic, and histologic responses were assessed for the worst and predupilumab endoscopies compared with the postdupilumab endoscopy.
Results: 46 patients with refractory fibrostenotic EoE who were treated with dupilumab were identified. Patients showed endoscopic, histologic, and symptomatic improvement on dupilumab compared with both the worst and the predupilumab esophagogastroduodenoscopies. The peak eosinophil counts decreased markedly, and postdupilumab histologic response rates were 80% and 57% for < 15 eosinophils per high-power field and ≤ 6 eosinophils per high-power field, respectively, and the Endoscopic Reference Score decreased from 5.01 to 1.89 (p < 0.001 for all). Although the proportion of strictures was stable, there was a significant increase in the predilation esophageal diameter (from 13.9 to 16.0 mm; p < 0.001). Global symptom improvement was reported in 91% (p < 0.001).
Conclusions: In this population of severe, refractory, and fibrostenotic patients with eosinophilic esophagitis (EoE), most achieved histologic, endoscopic, and symptom improvement with a median of 6 months of dupilumab, and esophageal stricture diameter improved. Dupilumab has real-world efficacy for a severe EoE population, most of whom would not have qualified for prior clinical trials.