Dupilumab Shows Efficacy in Real-World Treatment of Eosinophilic Esophagitis
A systematic review and meta-analysis synthesized outcomes from retrospective studies to assess the real-world effectiveness of dupilumab for eosinophilic esophagitis (EoE), providing practical insights for clinicians managing EoE.
Although dupilumab is FDA-approved for EoE, real-world data informing everyday clinical use remain limited, the authors wrote in the Journal of Clinical Gastroenterology. This study helps to quantity dupilumab’s effectiveness and tolerability in routine practice treating patients with EoE.
Study Findings: Strong Symptomatic and Histologic Response
The meta-analysis included 5 retrospective studies involving 209 patients (mean age 22.1 years; 61% male). Data demonstrated an encouraging pooled symptom improvement rate of 89.2% (95% CI: 68.0%–97.0%, I²=58%). After dupilumab treatment, peak eosinophil counts dropped significantly from a mean of 47.13 eos/hpf to 6.44 eos/hpf (P < 0.001), indicating marked reduction in esophageal inflammation. Correspondingly, the Endoscopic Reference Score (EREFS) declined from 4.10 pre-treatment to 0.77 post-treatment (P < 0.001), reflecting endoscopic remission and mucosal healing. (PubMed)
Follow-up spanned approximately 5.7 months on average, during which injection site pain was the most frequently reported adverse event and was generally manageable with local anesthetics. Although limited by retrospective design and modest follow-up, these findings mirror results from clinical trials and support dupilumab’s utility in real-world settings.
Clinical Implications for Practice
“Our study shows that in a real-world scenario, administration of dupilumab for EoE induces histologic and endoscopic remission and symptomatic improvement. Hence, dupilumab can be considered a treatment option for EoE, especially in resistant cases,” the authors wrote. “Future studies should evaluate its long-term effectiveness for 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.”
The investigators added that the manageable safety profile observed in routine practice supports tolerability in diverse patient groups but advises clinicians to monitor for adverse reactions and tailor treatment duration based on individual response and tolerability.
Reference:
Garg A, Moond V, SVelpari S, Broder A, Mohan BP. Real-world effectiveness of dupilumab in eosinophilic esophagitis: a systematic review and meta-analysis. J Clin Gastroenterol. 2025;59(6):483-490. doi:10.1097/MCG.0000000000002146
