P3944 - Maintaining Low Eosinophil Counts With Stepdown Dupilumab Among Pediatric EoE Patients

Jennifer Dziwis, MD, MPH¹, Michaela Wagner, DO¹, Elizabeth T. Jensen, MPH, PhD², M. Angie Almond, RD¹, Steven Clayton, MD¹, Anca Safta, MD¹, Prerana Williamson, MD^1
1Wake Forest University School of Medicine, Winston-Salem, NC; ²Wake Forest University School of Medicine, Pfafftown, NC

Introduction: Weekly dosed dupilumab was approved in 2022 to treat EoE in adults and children ≥12 years weighing ≥ 40 kg. In January 2024, approval of dupilumab was extended to include children aged 1 year and older with weight-based weekly dosing. Given variability in disease presentation, severity of symptoms, and baseline height/weight differences within the pediatric population, there is a potential for different dosing requirements to sustain histologic remission. We aimed to assess the change in peak eosinophil count per high power field (eos/hpf) on endoscopic biopsy as pediatric patients underwent stepdown dosing from weekly to biweekly administration.

Methods: We conducted a retrospective cohort study of pediatric patients aged ≥12 years with histopathologic-confirmed eosinophilic esophagitis. Baseline demographic, histologic, endoscopic (EREFS) and symptoms were obtained prior to initiation of dupilumab. Histologic findings of peak < 15 eos/hpf and patient reported symptomatic improvement were used together to define disease response. Disease remission was defined as peak < 6 eos/hpf. For patients who reached disease response on weekly dupilumab, dosing was spaced to every other week and follow up endoscopy with biopsy was performed to assess for maintenance of response. McNemar’s test for comparison of paired dichotomous response was used to assess for clinical improvement with dupilumab from baseline to first follow-up EGD and for change in response with biweekly dosing.

Results: A total of 16 patients with a median age of 15 years (IQR= 13.8, 17) at time of baseline EGD were included. Baseline median eosinophil count on proximal, mid, and distal esophageal biopsies were 12 (IQR = 0.5, 43), 40 (10.5, 66.5), and 37.5 (12,74.3) respectively. On weekly dupilumab, histologic improvement (p< 0.01) was observed for both peak < 15 and < 6 eos/hpf. There was no significant change in histologic improvement for peak < 15 eos/hp or < 6 when patients stepped down to biweekly dosing.

Discussion: Initiation of weekly dupilumab resulted in significant histologic improvement in pediatric patients with EoE. Decreasing the dose frequency to biweekly did not lead to any significant reduction in histologic improvement or remission. Still, 3 patients experienced loss of histologic response with biweekly dosing. Therefore, there may be some patients for whom the decrease in dose is not appropriate. Further investigation with a larger sample size is needed to further delineate risk factors for loss of response.


Disclosures:


Jennifer Dziwis, MD, MPH¹, Michaela Wagner, DO¹, Elizabeth T. Jensen, MPH, PhD², M. Angie Almond, RD¹, Steven Clayton, MD¹, Anca Safta, MD¹, Prerana Williamson, MD¹. P3944 - Maintaining Low Eosinophil Counts With Stepdown Dupilumab Among Pediatric EoE Patients, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.