S1048 Effectiveness of Dupixent as a Maintenance Therapy in Patients With EOE: A Retrospective Analysis

Introduction: Eosinophilic esophagitis (EoE) is non-immunoglobulin E immune-mediated allergic process in the esophagus. Treatment of EoE includes elimination diet, proton pump inhibitors (PPI), topical/systemic steroids or esophageal dilation. In May 2022, dupilumab became the first FDA-approved biologic treatment modality for EoE. We aim to determine the long-term effectiveness of dupilumab as a maintenance therapy. Methods: Retrospective review of patients in Allegheny Health Network aged 18-89 years with EoE and being treated with dupilumab was done. Primary outcome included improvement in eosinophils after starting dupilumab. Secondary outcomes included improvement in dysphagia, admissions for food impaction, and dilations. Post hoc analysis was performed according to the interval between initiation of dupilumab and latest esophagogastroduodenoscopy (EGD). ANOVA/Kruskal Wallis’ test and Chi-square were conducted to compare continuous and categorical variables respectively. P-value less than 0.05 was considered significant. Results: In total, 45 patients were included in the study. Mean interval between diagnosis and starting dupilumab was 3.57 years. Thirty-seven point eight percent, 64.4%, and 55.6% of patients had seen a nutritionist, allergist and tried diet elimination respectively. A majority of the patients were being treated with PPI (43, 96%) and steroids (38, 84.4%). There was a significant difference between the number of eosinophils between proximal/mid and distal esophagus after starting dupilumab (proximal/mid: 30 (20-50) vs 0 (0-0); P < 0.001 and distal: 40 (30-50) vs 0 (0-3); P < 0.001). Eighty-six point seven percent of patients reported improvement in dysphagia. Significant difference was noted in Endoscopic Reference Score (EREFS) (pre vs post: 2 (2-3) vs 1 (0-2); P < 0.05). There was significant reduction in the number of dilations required and admissions for food impactions post-dupilumab (P < 0.05). Post-hoc analysis was performed according to the latest EGD. Seventeen patients had EGD within 6 months after dupilumab, 19 between 6-12 months, and 9 after 12 months (up to 31 months). Notably, there was significant difference noted in eosinophils between pre- and post-EGD in all the 3 subgroups, however, no difference was noted in EREFS score, number of dilations and admissions for food impactions. Conclusion: Patients who underwent endoscopic evaluation after starting dupilumab at 6 months, 6-12 months, and beyond 12 months showed consistent improvement in eosinophil levels across all time points, indicating promising long-term treatment response with continued maintenance therapy.