Dupilumab Emerges as an Effective Antibody Therapy for Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a chronic allergic disease with a complex pathogenesis driven by an abnormal type 2 immune response to food or environmental allergens in the setting of impaired esophageal epithelial function. The goals of EoE treatment are to reduce esophageal inflammation, improve symptoms, and prevent complications. Traditionally, anti-inflammatory treatments included proton pump inhibitors, swallowed or topical corticosteroids, and food elimination diets, while esophageal dilation was used for strictures. Dupilumab is a human monoclonal antibody that functions as an interleukin-4 receptor-alpha antagonist, leading to blockade of IL-4 and IL-13, which are key factors in EoE pathogenesis. This article discusses the rationale for dupilumab use in EoE, reviews the clinical trial data across the lifespan as well as emerging real-world data, highlights guideline recommendations and the role of dupilumab in the evolving treatment paradigm for EoE, and notes future directions for research.