S912 Dupilumab Treatment Patterns for Eosinophilic Esophagitis in the United States: A Real-World Study

Introduction: Dupilumab, a fully human monoclonal antibody, inhibits interleukin (IL)-4 and IL-13 signaling pathways, which are central drivers of type 2 (T2) inflammation in eosinophilic esophagitis (EoE) and related T2 conditions. Clinical trials have established the efficacy and safety of dupilumab in children, adolescents and adults for the treatment of EoE. This study describes clinical characteristics and treatment patterns of EoE patients receiving dupilumab in routine clinical practice in the US. Methods: In this retrospective study, records were extracted for newly diagnosed EoE patients (≥12 years) between January 01, 2018, and August 31, 2023 (index range; index is the EoE diagnosis date), confirmed by esophageal biopsy demonstrating peak eosinophil count (PEC) ≥15 eosinophils/high-power field (eos/hpf) within 90 days of diagnosis and had ≥1 known eosinophil count in the 12 months after index. We reported patient characteristics and treatment patterns for the subgroup of patients who received dupilumab for EoE between May 20, 2022, and August 31, 2023 (post-approval in EoE). Patients were followed for ≥12 months after initiating dupilumab, unless lost to follow-up. Results were summarized descriptively. Results: This analysis included 52 EoE patients (mean age: 30.1 [standard deviation (SD): 15.0] years; 71.2% men). Of 52 patients, 38.5% (N = 20) received dupilumab alone or in combination with proton pump inhibitor/swallowed topical corticosteroid (PPI/STC) as first treatments after EoE diagnosis, with all continuing dupilumab-based therapy until the end of follow-up (median duration: 2.2 years). Other first treatments included PPI alone (30.7%, N = 16), and PPI-STC (26.9%, N = 14). Common EoE-related symptoms at diagnosis were dysphagia (69.2%, N = 36), chest/throat pain (38.5%, N = 20), and food impaction (34.6%, N = 18). Findings at initial diagnosis: mean PEC, 40.8 (SD: 49.5) eos/hpf; esophageal abnormalities, 78.9% (N = 41). Common T2 and other comorbidities included allergic rhinitis (38.5%, N = 20), asthma (28.9%, N = 15), and gastroesophageal reflux disease (44.2%, N = 23). Conclusion: EoE patients treated with dupilumab had substantial symptom burden at diagnosis and high rates of comorbidities. Over one-third of dupilumab use was as first-line treatment. Results warrant cautious interpretation due to the low sample size. Understanding patient characteristics of dupilumab users may aid physicians in making informed decisions, particularly on biologic initiation in EoE.