Dupilumab as an effective therapy for eosinophilic esophagitis in pediatric patients weighing less than 15 kilograms

Abstract Objectives Eosinophilic esophagitis (EoE) is a type 2 cytokine‐mediated chronic inflammatory condition leading to esophageal dysfunction. Dupilumab blocks IL‐4 and IL‐13 signaling, which are key inflammatory mediators in EoE and other allergic disorders. In the United States, the Food and Drug Administration (FDA) has approved the use of dupilumab in children and adults with doses that vary by age, weight and indication. Dupilumab is currently approved for EoE in children above 1 year of age and weight greater than 15 kg. There is an unmet need to extend the use of dupilumab for children with EoE below this weight threshold and there is a paucity of data. We seek to describe the safety and efficacy of dupilumab in treating EoE at doses approved for eczema in children weighing less than 15 kg. Methods The retrospective chart review was approved by the Institutional Review Board (IRB) at Children's Hospital Los Angeles. A search for patients with a diagnosis of EoE treated with dupilumab for any indication between 2019 and 2024 identified four patients weighing less than 15 kg. Results This report highlights a single‐center experience with dupilumab in four patients with EoE weighing less than 15 k. All patients had clinical improvement. Three patients had follow‐up endoscopy demonstrating endoscopic and histologic improvement. No significant adverse effects were noted. Conclusions In our limited experience, dupilumab was safe and effective in four EoE patients weighing less than 15 kg using the FDA‐approved dose for atopic dermatitis. Prospective trials are needed to optimize dosing and provide comprehensive safety and efficacy data.