In a report (I Hirano, ES Dellon et al. Gastroenterol 2020; 158: 111-22) on a phase 2 trial with 47 adults, the authors show that weekly subcutaneous injections of dupilumab (300 mg) was associated with improvement in eosionophilic esophagitis.

Dupilumab, a fully human monoclonal antibody, antagonizes the interleukin-4 receptor-alpha component of the type 2 receptor, thereby inhibiting signaling of IL-4 and IL-13. Dupilumab has shown “efficacy in pediatric and adult atopic dermatitis, asthma, and chronic sinusitis with nasal polyposis” and is FDA-approved for use in these disorders.

Key findings:

• Dupilumab was associated with improvement in dysphagia as measured by the Straumann Dysphagia Instrument with a mean reduction of 3.0 compared to 1.3 in the placebo group at week 10 (P=.0304)
• Dupilumab was associated with improvement in histology, at week 12, the peak eosinophil count had dropped by a mean of 86.8 (P<.0001 vs. placebo)
• Dupilumab was associated with improvement in endoscopic parameters as assessed by endoscopic reference score which dropped by 1.6 (P -.0006 vs placebo)
• No serious adverse effects were evident.  Nasopharyngitis was noted in 17% in the dupilumab group compared to 4% of placebo-treated patients.  Injection site erythema was noted in 35% (vs. 8% in placebo group

Of note, the study was sponsored by pharmaceutical companies and many of the authors (including both lead authors) were either affiliated with these companies.

My take: This study indicates that Dupilumab has at least short term efficacy and safety for eosinophilic esophagitis.

Related blog posts:

• Promising Biologic for Eosinophilic Esophagitis
• Transnasal Endoscopy (Unsedated) for EoE
• How Genetics Influence Response Rate to PPIs in EoE
• Association and Causation: Early Life Risk Factors for Eosinophilic Esophagitis
• Negligible Effect of Eosinophilic Esophagitis Treatment on Longitudinal Growth
• Increased Risk of EoE with TEF/EA
• What is EoE?
• EoE Update 2018 (Dr. Seth Marcus)
• Updated Consensus Guidelines for Eosinophilic Esophagitis
• Time to Diagnosis in Eosinophilic Esophagitis
• Adrenal Insufficiency due to Fluticasone in EoE
• Higher Doses of Topical Steroids for Eosinophilic … – gutsandgrowth

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