Outcomes of Dupilumab Treatment in Refractory Eosinophilic Esophagitis: A Retrospective Cohort Study from Saudi Arabia.

BACKGROUND

Dupilumab, an IL-4 and IL-13 inhibitor, has been approved for the treatment of eosinophilic esophagitis (EoE), a type two inflammatory disease. Few studies from Saudi Arabia have reported the prevalence and characteristics of EoE and treatment response, particularly dupilumab.

OBJECTIVE

To report dupilumab treatment outcomes in adult Saudi patients with EoE.

METHODS

This retrospective cohort study included all adult treatment-refractory EoE patients who received subcutaneous dupilumab 300 mg between January 2023 and November 2024 at a tertiary hospital in Riyadh, Saudi Arabia. Patient demographics, clinical characteristics, and procedural data were recorded. The primary outcome was to evaluate clinical response to dupilumab, and the secondary outcome was to compare Endoscopic Reference Score (EREFS) and histological outcome following dupilumab treatment with baseline assessments.

RESULTS

A total of 22 patients were included (mean age: 29.7 ± 11.2 years; male: 63.6%). At baseline, most had dysphagia to solids (95.5%) and type 2 inflammatory comorbidities (72.7%). In addition, all patients were on PPIs and had >15 eosinophils/hpf on histology. After dupilumab treatment, 91% (95% CI: 74.3%-97.9%) achieved symptomatic improvement. Post-dupilumab esophagogastroduodenoscopies were performed in 21 patients (median duration: 9.5 months), and most showed reduced inflammatory features. EREFS scores decline from a median of 3 units at baseline to 1 unit after dupilumab treatment (P <0.001). Histological remission (<15 eosinophils/hpf) was achieved in 87.5% of biopsied patients (63% of total cohort). Adverse events occurred in 27.3%, mainly injection-site reactions (66.7%).

CONCLUSION

In this cohort study of Saudi adults with refractory eosinophilic esophagitis, dupilumab treatment was associated with significant clinical, endoscopic, and histological improvements, in addition to having an acceptable safety profile.