S4371 Concurrent Use of Dupilumab and Other Biologics in Eosinophilic Esophagitis (EoE) Patients With Concomitant Immune-Mediated Conditions: A Case Series

Introduction: Eosinophilic esophagitis (EoE) is an immune-mediated disorder of the esophagus. EoE can coexist with other immune-mediated comorbid conditions, e.g., inflammatory bowel disease (IBD), asthma, and psoriatic arthritis (PsA), that may require treatment with other biologic therapies. While dupilumab is approved for EoE, there are limited data regarding its use alongside other biologics. Herein, we report a case series of 3 patients diagnosed with EoE and other inflammatory conditions who are being treated with dupilumab in combination with another biologic agent. Case Description/Methods: Patient 1 is a 39-year-old woman with a 23-year history of Crohn’s disease and a 12-year history of EoE. She transitioned from vedolizumab to infliximab (IFX) for IBD management. She has been on dupilumab for EoE for 2 years. On IFX and dupilumab, she had 1 mild Crohn’s flare status post a topical budesonide course with resolution. Her IBD and EoE remain in remission on infliximab and dupilumab, respectively, with no infections or routine laboratory abnormalities. Patient 2 is a 32-year-old man with a 15-year history of Crohn’s colitis and a 6-year history of EoE. He has been on IFX for IBD for 8 years and started dupilumab 6 months ago for EoE with improvement of dysphagia. He later developed influenza A and community-acquired pneumonia, both of which were successfully treated. Leukocytosis was transient and infection related. He remains in clinical remission. Patient 3 is a 52-year-old woman diagnosed with EoE and asthma 3 years ago status post dupilumab with improvement. She developed psoriatic arthritis 1 year ago. She initially received adalimumab and later switched to secukinumab with improved PsA control. She has reported no adverse events on dupilumab and secukinumab. Routine laboratory evaluations remain normal. All conditions remain well controlled. Discussion: In this case series, concurrent use of dupilumab with other biologics (infliximab, adalimumab and secukinumab) appears safe, well tolerated and effective. There was 1 mild IBD flare on dupilumab in patient 1 that did not occur in patient 2. A treatable respiratory tract infection was seen in patient 2. PsA developed on dupilumab that was controlled by secukinumab. No patient experienced persistent lab abnormalities, EoE flares, or systemic immune-related complications. The combined use of dupilumab with other biologic agents is becoming increasingly common as new therapies are introduced. Further studies are needed to assess long-term outcomes.