Dupilumab shows promising results in treating paediatric eosinophilic oesophagitis

Approved by the FDA in 2020 for patients aged 12 and older, dupilumab, a monoclonal antibody against the IL-4 receptor, has shown significant improvements in various histopathological parameters in paediatric eosinophilic oesophagitis (EoE).

The study included 14 paediatric patients aged 4-19 years, diagnosed with EoE, whose oesophageal biopsies were analysed before and after dupilumab treatment [1]. Histologic remission was defined by a peak eosinophil count (PEC) of less than 15 on follow-up biopsy, assessed by a pathologist. The biopsies were evaluated using both traditional analysis by a pathologist and a validated AI model (Aiforia Technologies) for quantitative analysis of histopathologic features. The primary endpoints evaluated were PEC and EoE Histologic Scoring System (EoE-HSS) grade, assessing improvements in basal zone hyperplasia (BZH) and dilated intercellular spaces (DIS). Secondary endpoints included lymphocyte counts and the correlation of histologic changes with endoscopic reference scores (EREFS).

The results were reported by Dr Puanani Hopson (Mayo Clinic, MN, USA) and her colleagues. Of the 14 participants, 10 achieved histologic remission, showing a median decrease of 79.3% in PEC and 93.4% in the average eosinophil count per 0.24 mm² by AI analysis. Reductions were also observed in BZH (56.7%) and DIS (45.6%) in those who achieved remission. Additionally, a 30.3% decrease in peak lymphocyte count was noted in patients in remission, while those not in remission showed a 20.4% increase. Correlation analysis for all participants indicated a moderate correlation (r=0.38) between EREFS changes and AI PEC changes and a weaker correlation (r=0.25) between EREFS changes and AI DIS changes.

The study confirms that dupilumab improves EoE-related histologic findings in paediatric patients, with AI-based quantitative assessments providing results comparable with traditional pathologist’s evaluation. These findings highlight the potential of dupilumab as an efficacious treatment for EoE, offering a promising option for improving patient outcomes.

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   1. Hopson P, et al. Quantitative assessment of dupilumab treatment in pediatric patients characterized by an artificial intelligence analysis of histopathologic features of eosinophilic esophagitis. Sa2054, DDW 2024, 18–21 May, Washington, DC USA.

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Posted on 11 July 2024