P2738 - Endoscopic and Histologic Efficacy of Dupilumab: A Real-World Retrospective Case Series

Oscar Noble, MD¹, Ana Paola Islas Guerra, MD¹, Hannah O'Neill, MD², Nandini Ray, MD³, Poojasree Pasupuleti, MS¹, Christopher Fan, MD⁴, Neha Mathur, MD⁵
1Houston Methodist Hospital, Division of Gastroenterology and Hepatology, Lynda K. and David M. Underwood Center for Digestive Health / Houston Methodist Research Institute, Department of Medicine, Houston, TX; 2Houston Methodist-Weill Cornell Graduate School of Medical Sciences, Houston, TX; 3Houston Methodist Hospital, Houston, TX; 4Houston Methodist Hospital, Division of Gastroenterology and Hepatology, Lynda K. and David M. Underwood Center for Digestive Health / Houston Methodist Research Institute, Department of Medicine / Weill Cornell Medical College, Cornell University, Houston, TX; 5Houston Methodist Hospital, Division of Gastroenterology and Hepatology, Lynda K. and David M. Underwood Center for Digestive Health, Houston, TX

Introduction: Eosinophilic esophagitis (EoE) is a chronic, progressive, type 2 immune-mediated disorder characterized by esophageal-eosinophilic infiltration and progressive fibro-stenotic remodeling. Dupilumab, an IL-4 receptor α antagonist, inhibiting IL-4 and IL-13 related inflammation, approved for EoE, has demonstrated efficacy in reducing endoscopic, clinical, and histologic disease activity in trials. We aimed to provide real-world data on dupilumab’s efficacy outside of controlled environments.

Methods: Patients were retrospectively identified from an institutional electronic medical record. Inclusion criteria were ≥1 ICD-10 code for EoE, treatment with dupilumab, and having pre- and post-dupilumab esophagogastroduodenoscopies with biopsies. Relevant clinical, endoscopic, and histological features were obtained through manual review of the charts. Pre- and post-dupilumab comparisons were evaluated with paired Wilcoxon signed-rank tests.

Results: A total of 14 patients were included of which 93% were non-Hispanic Caucasians and 64% were male. The median age at EoE diagnosis was 37 years (23–44), the median time from diagnosis to dupilumab initiation was 49 months (29–111), and the median time of dupilumab exposure was 369 days (189–642). Asthma was the most common atopic comorbidity (57%) while 29% had no atopic comorbidity. Pre-dupilumab management for EoE included viscous budesonide (64%) and inhaled fluticasone (7%), which were discontinued post-dupilumab. All patients were on proton pump inhibitors before and during dupilumab. Elimination diet was followed by 36% of patients pre-dupilumab, but none required it post-dupilumab. History of endoscopic food disimpaction and endoscopic dilation was required in 50% and 29% of patients, respectively, and neither was required post-dupilumab. The summary of characteristics is found in Figure 1. Statistically significant histologic and endoscopic improvements were observed pre- and post-dupilumab. Distal eosinophil counts decreased from 53 (35–64) to 0 (0–1), p = 0.00049, proximal counts from 33 (4–66) to 0 (0–0), p = 0.00244, and EREF scores improved from 3 (2–5) to 1 (0–2), p = 0.0105, results are illustrated in Figure 2.

Discussion: Dupilumab was associated with significant histologic and endoscopic improvement in this real-world cohort. These findings support its effectiveness in clinical practice, with potential to enhance quality of life, reduce invasive interventions, and improve long-term outcomes.




Disclosures:


Oscar Noble, MD¹, Ana Paola Islas Guerra, MD¹, Hannah O'Neill, MD², Nandini Ray, MD³, Poojasree Pasupuleti, MS¹, Christopher Fan, MD⁴, Neha Mathur, MD⁵. P2738 - Endoscopic and Histologic Efficacy of Dupilumab: A Real-World Retrospective Case Series, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.