Dupilumab in Eosinophilic Esophagitis in Children: A Large Retrospective Multicenter Study

Abstract

Background: Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease of the esophagus. Adult study demonstrated effectiveness of dupilumab in the treatment of EoE. The aim of this study was to describe children who were difficult-to-treat EoE with conventional treatment and to identify symptomatic, histologic, and endoscopic improvement after dupilumab treatment. Methods: A retrospective, multicenter study of children who confirmed EoE were conducted. We completed the chart review who were prescribed dupilumab for EoE. Demographic information, symptoms, endoscopic and histologic findings, and medications were collected. Response to dupilumab was evaluated. Results: We identified 11 patients in the present study. The study population comprised 7 males (64 %) and 4 female (36 %). The median age at presentation was 11.6 years (range, 8–13 years). Dupilumab at a dose of 200-300 mg was administrated in all patients as second-line therapy for children with EoE who refractory to conventional therapy (proton pump inhibitors, corticosteroids, and dietary restrictions). The study reported the effectiveness of dupilumab in symptoms, endoscopy, and histology were 82%, 73% and 90%, respectively. The mean EoE Endoscopic Reference Scoring System Scores (EREFS) changed from baseline 9.4 (prior to dupilumab) to 0.5 (post dupilumab). In addition to improvement in EoE, all patients reported decreased corticosteroid use in EoE and decreased inhaled corticosteroid in asthma, suggesting that dupilumab has the potential to be effective in patients with multiple concurrent atopic conditions. Dupilumab is well-tolerated safety profile except one patient who developed conjunctivitis. Conclusions: This first largest pediatric study adds to the effectiveness of dupilumab in symptoms, endoscopy, and histology of EoE as a second-line therapy who refractory to current therapy. A longitudinal large prospective study is necessary for guidance on how to initiate dupilumab for treatment of childhood EoE and long follow-up data on dupilumab.