P0502 - Efficacy and Safety of Dupilumab in Patients With Eosinophilic Esophagitis: Pooled Analysis and a Systematic Review

Murad Qirem, MD¹, Shahd Yaghi, MD¹, Gowthami Sai Kogilathota Jagirdhar, MD², Byron Okwesili, MD¹, Raed Atiyat, MD¹, Dema Shamoon, MD³, Yatinder Bains, MD¹, Mehul Shah, MD¹, Theodore DaCosta Jr, MD^1
1New York Medical College - Saint Michael's Medical Center, Newark, NJ; ²Saint Michaels Medical Center, Newark, NJ; ³Geisinger Community Medical Center, Danville, PA

Introduction: Eosinophilic esophagitis (EoE) is characterized by eosinophilic infiltration of the esophageal mucosa, resulting in symptoms like dysphagia, and food impaction. Dupilumab, a monoclonal antibody targeting interleukin-4 receptor alpha, has emerged as a promising candidate for EoE management, as Interleukin-4 plays a pivotal role in EoE pathogenesis by promoting eosinophil and inflammatory cell activation in the esophagus.

This systematic review explores the current research on Dupilumab in EoE, presenting key findings from available studies.

Methods: A literature search across PubMed, Embase, and Cochrane identified two clinical trials (N=368) and one retrospective cohort study (N=46). Extracted baseline data included Edema, Rings, Exudates Furrows, and Strictures (EREFS) scores, as well as baseline peak eosinophil count. Efficacy outcomes, such as histological remission rate (< 6 eso/hpf), changes in EREFS, peak eosinophil count, and proportion of patients achieving < 15 eso/hpf, were also extracted. Safety assessment covered total and serious adverse events. We combined all patients that received placebo into one group and Dupilumab in one group and analyzed the pooled data.

Results: The pooled results from the three studies revealed notable outcomes in the efficacy and safety of Dupilumab for the treatment of EoE.

Histological remission was achieved in a total of 63% (162/257) of patients receiving Dupilumab, compared to the 4% (7/141) in the placebo groups. Furthermore, 82% (213/257) of Dupilumab-treated patients reached esophageal intraepithelial eosinophil count < 15 eosinophils/hpf, while 6% (9/141) in the placebo groups achieved this outcome. In addition, significant improvements in EREFS score were observed when Dupilumab was administered in comparison to placebo.

Although adverse events were more prevalent in the Dupilumab group (81%, 184/227) compared to placebo (72%, 102/141), the overall safety profile remained acceptable. Serious adverse effects were rare in both groups with a pooled rate of 0.7%, (1/141) and 3% (8/227) in Dupilumab and placebo respectively.

Discussion: In summary, this systematic review suggests that Dupilumab effectively induces histological remission and improves clinical outcomes in EoE patients. The safety profile appears favorable when compared to placebo, with low rates of total and serious adverse events. These findings underscore the potential of dupilumab as a promising therapeutic option for managing eosinophilic esophagitis.


Disclosures:


Murad Qirem, MD¹, Shahd Yaghi, MD¹, Gowthami Sai Kogilathota Jagirdhar, MD², Byron Okwesili, MD¹, Raed Atiyat, MD¹, Dema Shamoon, MD³, Yatinder Bains, MD¹, Mehul Shah, MD¹, Theodore DaCosta Jr, MD¹. P0502 - Efficacy and Safety of Dupilumab in Patients With Eosinophilic Esophagitis: Pooled Analysis and a Systematic Review, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.