S914 Efficacy of Dupilumab Therapy in Eosinophilic Esophagitis: A Systematic Review and Meta-Analysis

Introduction: Eosinophilic esophagitis (EoE) is defined as a chronic, immune mediated, esophageal inflammation characterized histologically by eosinophilic infiltration. Dupilumab, an Interleukin 4 receptor alpha antagonist, which by its mechanism of action inhibits predominantly the humoral immunity, as well as reduces eosinophil recruitment. Various randomized controlled trials have been done in the past, substantiating the safety and efficacy of dupilumab vs standard therapy previously in use. The systematic review and meta-analysis conducted aims to further assess the safety and efficacy of dupilumab in EoE. Methods: The review conducted follows the PRISMA guidelines and major medical databases, which include PUBMED, Google Scholar, and ScienceDirect, were extensively searched using a comprehensive search term to identify and retrieve available articles. The articles that included the assessment of histological remission of EoE following dupilumab therapy were included in the final analysis. The data was analyzed using the Meta, Metadata, and Metafor packages of R Studio. The pooled proportion of the histological remission of EoE following dupilumab therapy was assessed as our primary outcome. The pooled reduction in mean change of the Eosinophilic Esophagitis Histologic Scoring System (EoEHSS) was considered as the secondary outcome. The data was analyzed using the Meta, Metadata, and the Metafor packages of R Studio. The inverse variance method was utilized to analyze the odds ratio. The I2 test was used to assess the heterogeneity of the studies. Results: The study included a total of 10 trial groups between 2 different subgroups based on different dosage schedules of dupilumab, i.e., 300 mg weekly and 300 mg biweekly. The pooled proportion of subjects having complete histological remission of EoE was estimated to be 70% (0.70 [0.63;0.77]; P < 0.01; I2 = 81%). The mean reduced change in EoEHSS following dupilumab therapy was estimated to be 0.95 (0.54; 0.37; I2 = 100%; P < 0.01). Conclusion: Improvement in symptomatic scores and histological outcomes indicates that dupilumab is an effective therapy in the treatment of EoE and should be considered as an effective intervention. In future dupilumab trials and studies, further analysis of endoscopic outcomes and monitoring of the symptoms after starting dupilumab are recommended to measure the potential benefits of the therapy and assess outcomes.