P3938 - Real-World Effectiveness of Dupilumab in Eosinophilic Esophagitis: A Systematic Review and Meta-Analysis

Archit Garg, MD¹, Vishali Moond, MD¹, Arkady Broder, MD¹, Babu Mohan, MD^2
1Saint Peter's University Hospital, New Brunswick, NJ; ²Orlando Gastroenterology PA, Orlando, FL

Introduction: Dupilumab, a human monoclonal antibody against interleukin-4 receptor alpha subunit, is the only FDA approved medication for eosinophilic esophagitis (EoE). Clinical trials have shown its effectiveness in alleviating symptoms and decreasing inflammation associated with EoE. However, real-world data on efficacy of dupilumab is still limited.

Methods: We searched multiple databases including Medline, Web of Science, Cochrane Library, Pubmed, Embase and conference proceedings from inception through June 2024 for articles reporting outcomes of dupilumab for treatment of EoE. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied by I2 statistics.

Results: We analyzed 5 retrospective studies (209 subjects). Mean age was 22.12 +/- 12.01 years and 61.24% were males. Among the subjects, pooled association with atopic conditions was 87% [Cl 71.5 - 94.7%; I2 = 64%]. Out of this, 56.1% had asthma, 51.9% had associated food allergies, 37.4% had atopic dermatitis, and 8.9% had nasal polyps. 98.4% [Cl 92.4 - 99.7%; I2 = 0%] had received prior treatment for EoE, in the form of proton-pump inhibitors, dietary modification and/or topical corticosteroids. The mean duration of treatment and follow up was 5.66 +/- 1.14 months. The pooled outcome for symptom improvement with dupilumab treatment was 89.2% [Cl 68.0 - 97.0%; I2 = 58%]. Peak eosinophil count as seen on histology improved markedly post dupilumab (Pre: 47.13 [Cl 45.5 - 48.67; I2 = 98%] vs Post: 6.44 [Cl -0.72 - 13.60; Cl = 98%] eosinophils/high power filed; SD 15.53 +/- 2.28 and p-value < 0.001). There was a significant reduction in Endoscopic Reference Score (EREFS) with treatment (Pre: 4.10 [Cl 1.74 - 6.43; I2 = 95%] vs Post: 0.77 [Cl -0.14 - 1.7; Cl = 95%] with SD 2.18 +/- 0.30 and p-value < 0.001). The most common adverse event reported was pain due to injection which was controlled with local anesthetics.

Discussion: Our study shows that in a real-world scenario, administration of dupilumab for EoE induces histologic and endoscopic remission. Moreover, patients with EoE have significant symptom improvement with dupilumab. Hence, dupilumab can be considered as a treatment option for EoE, especially in resistant cases. Future studies should evaluate its long term effectiveness with respect to preventing esophageal fibrosis/ stricture and long term side effect profile. Furthermore, cost-effectiveness analysis is warranted to help establish its role as a potential first-line treatment strategy.


Disclosures:


Archit Garg, MD¹, Vishali Moond, MD¹, Arkady Broder, MD¹, Babu Mohan, MD². P3938 - Real-World Effectiveness of Dupilumab in Eosinophilic Esophagitis: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.