Efficacy of Dupilumab for Induction and Maintenance of Remission in Patients With Eosinophilic Gastritis, Enteritis, and Colitis With Concomitant Eosinophilic Esophagitis.

BACKGROUND

Eosinophilic gastrointestinal diseases (EGIDs) are chronic, immune-mediated diseases characterized by pathological infiltration of eosinophils in the gut. EGIDs include eosinophilic esophagitis (EoE), gastritis (EoG), enteritis (EoN), and colitis (EoC). There are no approved drugs for non-EoE EGIDs due to a lack of evidence.

AIMS AND

METHODS

In this case series, we report the efficacy of dupilumab-prescribed for concomitant EoE-for the induction and maintenance of remission of non-EoE EGIDs. Adult patients (> 18 years) diagnosed with non-EoE EGIDs and concomitant EoE who had been prescribed dupilumab 300 mg weekly were prospectively enrolled. Outcome assessment was performed according to EGID-specific instruments when available (i.e., peak eosinophil count, modified dysphagia questionnaire, Pisa EoE adaptation questionnaire, EoE and EoG endoscopic reference scores).

RESULTS

Four patients were included. All were female and their age spanned 21-77 years at diagnosis. Two patients had EoE + EoG (case 1 and 2), one EoE + EoG + EoN (case 3), and one EoE + EoN + EoC (case 4). EoG presented with epigastric pain, while EoN and EoC presented with abdominal pain and diarrhea. Cases 1 and 2 achieved clinical, endoscopic, and histological remission with induction corticosteroid treatment, while case 3 did not, and case 4 developed steroid-related adverse events. When switched to dupilumab 300 mg weekly, cases 1, 2, and 3 achieved histological remission and sustained clinical remission up to 12-18 months from induction. In case 4, dupilumab achieved histologic remission and partial clinical response up to 16 months from induction.

CONCLUSION

Dupilumab, prescribed for EoE, may be effective for the management of concomitant non-EoE EGIDs.