Dupilumab Administration in the Patient with Severe Eosinophilic Esophagitis Combined with T2-Associated Diseases: Case Study

Background. T2-associated diseases such as eosinophilic esophagitis (EoE), atopic dermatitis, and bronchial asthma have common pathogenetic mechanism — hyperproduction of interleukins (IL) 4, 5 and 13. Standard therapy for severe forms of EoE and comorbid T2 pathologies may be ineffective. Dupilumab (monoclonal antibody to the IL-4R receptor) selectively blocks IL-4/IL-13 signaling pathways. Thus, this medication can be considered as the promising treatment option for EoE with refractory course and multiple atopic conditions. Case description . Child with EoE complicated by esophageal stenosis, comorbid atopic dermatitis, and allergic rhinitis, with ineffective standard therapy (proton pump inhibitors, topical corticosteroids, and elimination diet), was prescribed dupilumab, 300 mg every 2 weeks (child’s weight of 34 kg, total dosage was 800 g). Dysphagia and abdominal pains resolved 3 months after biological therapy onset. The patient has started eating solid food, his appetite has improved. Normalization of physical development indicators (HAZ, BAZ) was noted. Remission of atopic dermatitis was achieved during the therapy, and endoscopic esophageal dilation was avoided. No side effects were reported due to dupilumab therapy. Conclusion. Dupilumab significantly reduces eosinophilic infiltration of esophageal mucosa and symptoms severity in the patient with severe EoE combined with T2-associated diseases. This medication opens new possibilities for personalized therapy of patients with EoE via modulating effect on genetically determined T2-inflammation.