Efficacy of Dupilumab on Facilitated Food Reintroduction in Eosinophilic Esophagitis.

Background & aims: Eosinophilic esophagitis (EoE) is a chronic, type 2 inflammatory disease of the esophagus commonly triggered by food allergens. Eliminating dietary EoE trigger foods can effectively treat EoE in some cases, but maintaining adherence can be challenging and can reduce quality of life. We aimed to assess the efficacy of dupilumab on reintroducing these foods based on clinical outcomes in patients with EoE.

Methods: We conducted an open-label pilot study in which patients aged 6 to 25 years with EoE induced by milk, egg, soy, or wheat were treated with weight- and age-tiered dupilumab for 3 months, followed by standardized reintroduction of trigger foods at months 3, 6, and 9, while continuing on dupilumab treatment. Symptoms, histology, endoscopy, and esophageal diameter were compared prior to and following every phase of food reintroduction to month 12. All patients had previously failed trigger food reintroduction on their current EoE medication.

Results: Twenty-one patients were enrolled. All patients who completed the study were able to reintroduce at least one serving size of trigger foods by month 12, and 8 patients were able to add foods every 3 months. There was no worsening of any clinical outcome, including symptoms, histology, and esophageal diameter. There were no serious treatment-related adverse events.

Conclusion: Patients with EoE treated with dupilumab were able to safely reintroduce EoE trigger foods into their diet without exacerbation of histologic, endoscopic, or symptomatic measures of EoE severity. Some patients were able to reintroduce food at an earlier timepoint than others.

Clinicaltrials: gov, Number: NCT05247866.