S855 Therapeutic Role of Monoclonal Antibodies in Oeosinophilic Esophagitis: A Comprehensive Meta-Analysis

Introduction: Advances in the immunopathology of eosinophilic esophagitis (EoE) have driven the development of monoclonal antibody therapies targeting key inflammatory pathways. This meta-analysis compiles evidence from randomized controlled trials to evaluate the efficacy and safety of monoclonal antibodies in the treatment of EoE. Methods: We systematically searched PubMed, Google Scholar, Embase, and ClinicalTrials.gov proceedings through March 2025 to identify randomized controlled trials (RCTs) comparing monoclonal antibodies with placebo in patients with active EoE. Data was extracted into a spreadsheet and the meta-analysis was performed using RevMan 5.4. Outcomes assessed included histologic remission (defined as ≤15 eosinophils/high-power-field), symptomatic response, change in dysphagia scores, and serious adverse events (SAE). Pooled risk ratios (RR) and mean differences (MD) were calculated using random-effects models, with heterogeneity assessed using the I² statistic. Results: Ten RCTs comprising 1,320 patients met inclusion criteria. Monoclonal antibodies significantly increased the rate of histologic remission compared to placebo (RR 7.64; 95% confidence interval [CI] 3.66-15.96; I² = 85%). Symptomatic response was also greater with monoclonal antibodies (RR 1.91; 95% CI 1.03-3.55; I² = 89%). Pooled analysis of change in dysphagia scores demonstrated a non-significant trend favoring monoclonal antibodies (MD -3.72; 95% CI -7.93 to 0.50; I² = 98%). Rates of SAEs were low and not significantly different between groups (RR 1.42; 95% CI 0.54-3.75; I² = 0%). Conclusion: Monoclonal antibodies demonstrate significant efficacy in achieving histologic remission and improving symptomatic response in patients with EoE without an increase in serious adverse events. These findings support their potential role as effective therapeutic agents in EoE management. Further long-term studies are warranted to evaluate durability of response and optimal treatment strategies.