S918 Endoscopic and Histologic Efficacy of Dupilumab: A Real-World Retrospective Case Series

Introduction: Eosinophilic esophagitis (EoE) is a chronic, progressive, type 2 immune-mediated disorder characterized by esophageal-eosinophilic infiltration and progressive fibro-stenotic remodeling. Dupilumab, an Interleukin (IL)-4 receptor α antagonist, inhibiting IL-4 and IL-13 related inflammation, approved for EoE, has demonstrated efficacy in reducing endoscopic, clinical, and histologic disease activity in trials. We aimed to provide real-world data on dupilumab’s efficacy outside of controlled environments. Methods: Patients were retrospectively identified from an institutional electronic medical record. Inclusion criteria were ≥1 International Classification of Diseases-10 code for EoE, treatment with dupilumab, and having pre- and post-dupilumab esophagogastroduodenoscopies with biopsies. Relevant clinical, endoscopic, and histological features were obtained through manual review of the charts. Pre- and post-dupilumab comparisons were evaluated with paired Wilcoxon signed-rank tests. Results: A total of 14 patients were included of which 93% were non-Hispanic Whites and 64% were men. The median age at EoE diagnosis was 37 years (23-44 years), the median time from diagnosis to dupilumab initiation was 49 months (29-111 months), and the median time of dupilumab exposure was 369 days (189-642 days). Asthma was the most common atopic comorbidity (57%) while 29% had no atopic comorbidity. Pre-dupilumab management for EoE included viscous budesonide (64%) and inhaled fluticasone (7%), which were discontinued post-dupilumab. All patients were on proton pump inhibitors before and during dupilumab. Elimination diet was followed by 36% of patients pre-dupilumab, but none required it post-dupilumab. History of endoscopic food disimpaction and endoscopic dilation was required in 50% and 29% of patients, respectively, and neither was required post-dupilumab. Statistically significant histologic and endoscopic improvements were observed pre- and post-dupilumab. Distal eosinophil counts decreased from 53 (35-64) to 0 (0-1), P = 0.00049; proximal counts from 33 (4-66) to 0 (0-0), P = 0.00244; and endoscopic reference esophagus scores improved from 3 (2-5) to 1 (0-2), P = 0.0105. Conclusion: Dupilumab was associated with significant histologic and endoscopic improvement in this real-world cohort. These findings support its effectiveness in clinical practice, with potential to enhance quality of life, reduce invasive interventions, and improve long-term outcomes.