Dupilumab improves eosinophilic oesophagitis outcomes, regardless of history of oesophageal dilation

Eosinophilic oesophagitis (EoE) is a progressive inflammatory condition impairing oesophageal function, sometimes necessitating painful dilation. An analysis from the phase 3 LIBERTY-EoE-TREET study (NCT03633617) demonstrated that dupilumab enhances histological, symptomatic, and endoscopic outcomes in adolescents and adults with EoE, independent of prior oesophageal dilation history.

Dupilumab, the only FDA and EMA-approved treatment for EoE for individuals aged 12 and above, is a monoclonal antibody that exerts dual blockade of IL-4/IL-13, halting type 2 inflammation. Other treatments, such as proton-pump inhibitors and topical corticosteroids, although used, lack formal approval in the US.

"There are also specific diets used as a treatment for EoE. The goal of these diets is to avoid foods that cause inflammation, but it is a challenge to figure out which ones are problematic, and some patients fail to adhere to the recommended diet," pointed out Prof. Arjan Bredenoord (University of Amsterdam, the Netherlands) [1].

The 3-part LIBERTY-EoE-TREET trial has previously shown that weekly dupilumab 300 mg improved clinical, histologic, and endoscopic outcomes of EoE at week 24. A new prespecified analysis stratified participants from parts A and B with and without dilation history. The primary endpoints at week 24 were the proportion of participants achieving histologic remission and absolute change in the Dysphagia Symptom Questionnaire (DSQ) score. Key secondary endpoints included changes in the peak eosinophil count and EoE-Endoscopic Reference Score.

In parts A and B, 42.9% and 32.5% of dupilumab-treated participants, and 43.6% and 41.8% of placebo participants had a history of dilation. The mean DSQ score change in part A was -18.79 for dupilumab versus -6.53 for placebo among patients with a dilation history, and -20.79 versus -9.07 for those without it. In part B, the scores were -25.24 versus -12.16, and -24.28 versus -16.66, respectively. Dupilumab also improved the key secondary endpoints versus placebo, with comparable results in patients with or without a history of dilation.

These results demonstrate that dupilumab alleviates dysphagia, a major EoE symptom, regardless of prior oesophageal dilation. This data solidifies dupilumab's role in EoE treatment, demonstrating its long-term efficacy, regardless of previous steroid use or dilation history.

1. Bredenoord A, et al. Dupilumab improves histologic, symptomatic, and endoscopic aspects of eosinophilic esophagitis, regardless of prior history of esophageal dilation. Lecture 467, DDW 2023, 6–9 May, Chicago, IL, USA.

 

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Posted on 13 June, 202329 February, 2024