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 interleukin-4 receptor, has shown improvements in various histopathological and clinical metrics in paediatric eosinophilic oesophagitis (EoE).

The study included 14 paediatric EoE patients aged 4-19 years, 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. The biopsies were assessed using both traditional pathologist analysis and a validated AI model (Aiforia Technologies) for quantitative analysis of histopathologic features. The primary endpoints evaluated were PEC, EoE histology score (EoE-HSS), and improvements in basal zone hyperplasia (BZH) and dilated intercellular spaces (DIS). Secondary endpoints included lymphocyte counts and correlation of histologic changes with endoscopic reference scores (EREFS).

Of the 14 patients, 10 achieved histologic remission, showing a median decrease of 79.3% in PEC by AI analysis and 93.4% in the average eosinophil count per 0.24mm². Improvements 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 patients indicated a moderate correlation between EREFS changes and AI PEC changes, and a weaker correlation between EREFS changes and DIS AI changes.

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

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.

Medical writing support was provided by Federica Angius.

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Posted on 22 May 2024