Dupilumab improved outcomes in adolescents and adults with eosinophilic esophagitis independent of prior esophageal dilation history.
Dupilumab, the only FDA- and EMA-approved treatment for eosinophilic esophagitis (EoE) for individuals aged 12 and older, is a monoclonal antibody that exerts dual blockade of IL-4/IL-13, halting type 2 inflammation. Other treatments, such as proton-pump inhibitors and topical corticosteroids, although used, lack formal approval in the United States.
“There are also specific diets used as a treatment for EoE. The goal of these diets is to avoid foods that cause inflammation, but it is a challenge to figure out which ones are problematic, and some patients fail to adhere to the recommended diet,” pointed out Arjan Bredenoord, MD, PhD, at DDW 2023, held May 6-9 in Chicago.
The 3-part LIBERTY-EoE-TREET, a phase 3 trial, has previously shown that weekly dupilumab 300 mg improved clinical, histologic, and endoscopic outcomes of EoE at week 24. A new prespecified analysis stratified participants from parts A and B with and without dilation history. The primary endpoints at week 24 were the proportion of participants achieving histologic remission and absolute change in the Dysphagia Symptom Questionnaire (DSQ) score. Key secondary endpoints included changes in the peak eosinophil count and EoE-Endoscopic Reference Score.
In parts A and B, 42.9% and 32.5% of dupilumab-treated participants, and 43.6% and 41.8% of placebo participants had a history of dilation. The mean DSQ score change in part A was -18.79 for dupilumab versus -6.53 for placebo among patients with a dilation history, and
-20.79 versus -9.07 for those without it. In part B, the scores were -25.24 versus -12.16, and
-24.28 versus -16.66, respectively. Dupilumab also improved the key secondary endpoints versus placebo, with comparable results in patients with or without a history of dilation.
These results demonstrate that dupilumab alleviates dysphagia, a major EoE symptom, regardless of prior esophageal dilation. These data solidify dupilumab’s role in EoE treatment, demonstrating its long-term efficacy, regardless of previous steroid use or dilation history.
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