Dupilumab for Eosinophilic Esophagitis in Adolescents and Adults: Real-World Outcomes Across Different Dosing Regimens From the EoE CONNECT Registry.

INTRODUCTION

Real-world data on dupilumab for eosinophilic esophagitis (EoE), particularly regarding flexible dosing and fibrostenotic phenotypes, are scarce. We aimed to evaluate the effectiveness and safety of dupilumab in clinical practice using the EoE CONNECT registry.

METHODS

This cross-sectional analysis included all patients prospectively recruited in the largest European multicenter EoE registry. Baseline characteristics, dosing regimens (300 mg weekly vs semiweekly), clinicohistological response, dose adjustments, and treatment tolerability were assessed.

RESULTS

We analyzed 161 patients (145 adults; 16 adolescents). At baseline, 69.1% of patients displayed endoscopic fibrotic features (rings/strictures). After a median of 6.5 months, peak eosinophil count decreased from 57 ± 45 to 8 ± 19 eos/hpf, edema, rings, exudates, furrows, and strictures score declined from 3.0 ± 1.6 to 1.3 ± 1.3, and Dysphagia Symptom Score improved from 5.8 ± 3.7 to 2.5 ± 2.8 (all P < 0.001). Clinicohistological response was achieved by 86.0% of patients on 300 mg weekly and 81.2% on semiweekly dosing ( P = 0.57). Multivariate analysis identified severe atopy as the reason for starting dupilumab as the strongest predictor for semiweekly regimen choice (odds ratio: 26.9; P < 0.001), with conjunctivitis, asthma, and having 2 or more food allergies being significant. Both regimens were equally effective in reducing peak eos/hpf, symptomatology and edema, rings, exudates, furrows, and strictures. Dose tapering from weekly to semiweekly/monthly was successful in all evaluable cases (8/8), whereas dose escalation from semiweekly to weekly rescued 80% (4/5) of nonresponders. Discontinuation occurred only in 8 patients (5%), primarily because of adverse events.

DISCUSSION: Dupilumab is effective and safe in real-world EoE management, with no significant differences between weekly and semiweekly induction. Efficacy was generally regained after escalation or maintained after dose tapering.