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

Abstract

BACKGROUND Real-world data on dupilumab for eosinophilic esophagitis (EoE), particularly regarding flexible dosing and fibrostenotic phenotypes, are scarce. OBJECTIVE 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. semi-weekly), clinico-histological response (CHR), 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, EREFS score declined from 3.0±1.6 to 1.3±1.3, and DSS improved from 5.8±3.7 to 2.5±2.8 (all p<0.001). CHR was achieved by 86.0% of patients on 300 mg weekly and 81.2% on semi-weekly dosing (p=0.57). Multivariate analysis identified severe atopy as the reason for starting dupilumab as the strongest predictor for semi-weekly regimen choice (OR: 26.9; p<0.001), with conjunctivitis, asthma, and having two or more food allergies being significant. Both regimens were equally effective in reducing peak eos/hpf, symptomatology and EREFS. Dose tapering from weekly to semi-weekly/monthly was successful in all evaluable cases (8/8), while dose escalation from semi-weekly to weekly rescued 80% (4/5) of non-responders. Discontinuation occurred only in 8 patients (5%), primarily due to adverse events. CONCLUSION Dupilumab is effective and safe in real-world EoE management, with no significant differences between weekly and semi-weekly induction. Efficacy was generally regained after escalation or maintained after dose tapering.