Real-world Effectiveness of Dupilumab in Eosinophilic Esophagitis: A Systematic Review and Meta-analysis.

Abstract

Background: Dupilumab is the only FDA-approved medication for eosinophilic esophagitis (EoE). Clinical trials have shown its effectiveness in alleviating symptoms and decreasing inflammation associated with EoE. However, real-world data on its efficacy is still limited.

Methods: We searched multiple databases for articles reporting the outcomes of dupilumab for the treatment of EoE and conducted a meta-analysis.

Results: Five retrospective studies including 209 subjects (mean age: 22.12±12.01 y and 61.24% males) were analyzed. The pooled outcome for symptom improvement with dupilumab was 89.2% [95% Cl: 68.0%-97.0%; I2=58%]. Peak eosinophil count improved markedly postdupilumab [pre: 47.13 (95% Cl: 45.5-48.67; I2=98%) vs. post: 6.44 (95% Cl: 0.72-13.60; I2=98%) eos/hpf, P<0.001]. There was a significant reduction in Endoscopic Reference Score (EREFS) [pre: 4.10 (95% Cl: 1.74-6.43; I2=95%) vs. post: 0.77 (95% Cl: 0.14-1.7; I2=95%), P<0.001]. The mean duration of treatment and follow-up was 5.66±1.14 months. The most common adverse event reported was a pain due to injection, which was controlled with local anesthetics.

Conclusion: Our study shows that in a real-world scenario, administration of dupilumab for EoE induces histologic and endoscopic remission and symptomatic improvement. Hence, dupilumab can be considered a treatment option for EoE, especially in resistant cases. Future studies should evaluate its long-term effectiveness for preventing esophageal fibrosis/stricture and long-term side effect profile. Furthermore, cost-effectiveness analysis is warranted to help establish its role as a potential first-line treatment strategy.