Dupilumab improves clinical and histologic features of eosinophilic esophagitis prior to 12 weeks of treatment

• Published in: Clinical and translational allergy 2024-01, Vol.14 (1), p.e12333-n/a
• Main Authors: Sia, Twan, Miller, Amanda, Bacchus, Leeon, Young, Jennie, Narayan, Aditya P., Solecki, Rachel, Fu, Jerry, Jiang, Yuting, Khuda, Raisa, Liu, Stanley, Love, Kathleen, Mallik, Shibani, Matmatte, Amina Sara, McDonald, Paige, Telukunta, Tanvi, Roby, Alyssa, Shami, Saad, Zheng, Michelle, Headen, Madison, Leung, John
• Format: Article
• Language: English
• Subjects: Biopsy; Combination therapy; Dermatitis; Editing; Electronic health records; Endoscopy; Letter; Medical records; Patients; Visualization; Writing
• ISSN: 2045-7022; 2045-7022
• DOI: 10.1002/clt2.12333

1 EoE histologic remission with dupilumab has only been demonstrated in patients after at least 12 weeks of treatment. 2–6 Current guidelines recommend waiting for histologic re-evaluation of EoE until after 20–24 weeks of dupilumab. 1 It is unknown if increasing dupilumab treatment length improves its efficacy. Because histologic re-evaluation of EoE requires invasive biopsies, and inducing remission of EoE is important to prevent progressive esophageal damage, research investigating the effects of dupilumab on EoE prior to 12 weeks of treatment is warranted. Endpoints were peak eosinophil counts (eosinophils per high-power field; eos/hpf), EoE endoscopic reference scores (EREFS), and a composite symptom score in which each symptom (dysphagia, food impaction/choking, regurgitation/vomiting, heartburn/chest pain, and abdominal pain) was graded (0 = absent, 1 = mild, 2 = moderate, and 3 = severe) and summed. From the electronic medical record, 658 patients with EoE were identified, of which 534 had never initiated dupilumab, 6 did not have histologic confirmation of EoE, and 39 did not have a repeat histologic evaluation after dupilumab initiation. [...]79 patients were included in this study. Characteristics, median (Q1 to Q3) All included patients (n = 79) Patients on dupilumab for 0–12 weeks (n = 12) Patients on dupilumab for 12–24 weeks (n = 38) Patients on dupilumab for longer than 24 weeks (n = 29) p-value Change in composite symptoms scores −5.0 (−6.0 to −3.0) −5.5 (−6.0 to −4.0) −5.0 (−6.0 to −3.8) −3.0 (−6.0 to −2.0) 0.1350 Changes in peak eosinophil count (eos/hpf) −33.0 (−54.0 to −18.0) −24.5 (−54.3 to −5.5) −35.0 (−49.3 to −24.0) −45.0 (−78.0 to −25.0) 0.0746 Changes in EoE endoscopic reference scores −1.0 (−4.0 to 0.0) −2.0 (−4.0 to 0.50) −1.0 (−3.0 to 0.0) −1.0 (−2.0 to −0.25) 0.8771 Note: Change in EoE endoscopic reference scores is only available for 15 patients. p value corresponds to Kruskal-Wallis test comparing patients on dupilumab for 0–12, 12–24, and greater than 24 weeks.