Eosinophilic Esophagitis Symptoms Improved by Monoclonal Antibody Therapy

Dupilumab prescribed for other indications also improved symptoms of eosinophilic esophagitis, according to study results published in the Annals of Allergy, Asthma & Immunology.

“Dupilumab has been approved to treat atopic dermatitis, asthma, and nasal polyps and is in active clinical trials for treatment of eosinophilic esophagitis,” the authors wrote in the study background. “Given shared immunopathology, we hypothesized that eosinophilic esophagitis symptoms and inflammation would improve when dupilumab therapy was used for other allergic indications.”

The study was a retrospective chart review of all patients at the Children’s Hospital of Philadelphia and Rady Children Hospital, San Diego, who initiated dupilumab therapy for atopic dermatitis, asthma, or nasal polyps and had concomitant eosinophilic esophagitis. Among the 45 patients identified, 11 were prescribed dupilumab for asthma, 27 for atopic dermatitis, three for nasal polyps, and four for compassionate use for eosinophilic esophagitis. Follow-up data was not available for eight patients.

Follow-up histology, available for 26 patients, revealed that 22 patients had less than 6 eosinophils/high-power field after dupilumab initiation—improvement researchers characterized as significant. Additionally, 28 patients had eosinophilic esophagitis symptom improvement, 24 of whom had complete resolution of symptoms.

Twenty-nine patients were able to reduce eosinophilic esophagitis medications, such as swallowed steroids and proton pump inhibitors, or expand their diets after treatment with dupilumab.

“Dupilumab therapy initiated for atopic disease effectively induces symptomatic and histologic remission of esophageal disease and reduces the need for eosinophilic esophagitis-directed therapy in patients with concomitant eosinophilic esophagitis,” the authors concluded.

Reference:
Spergel BL, Ruffner MA, Godwin BC, et al. Improvement in eosinophilic esophagitis when using dupilumab for other indications or compassionate use. Ann Allergy Asthma Immunol. 2022 Jan 25;S1081-1206(22)00020-5. doi:10.1016/j.anai.2022.01.019