Dupilumab for Eosinophilic Esophagitis in Adolescents and Adults: Real-World Outcomes Across Different Dosing Regimens from the EoE CONNECT Registry
Emilio J Laserna-Mendieta, Victoria Úbeda-Vargas, Edurne Amorena, Edoardo V Savarino, Sergio Casabona-Francés, Marina Coletta, Javier Molina-Infante, Isabel Pérez-Martínez, Carlo María Rossi, Emanuele Dilaghi, Danila Guagnozzi, Leonardo Blas-Jhon, Elena Betoré, Sonia Fernández-Fernández, Juan Enrique Naves, Valentín Roales, Stefania Piccirelli, Alicia Granja-Navacerrada, Raúl Honrubia-López, Laura Martín-Asenjo, Gaia Pellegatta, Anne Lund Krarup, Diana Zaffalon, Silvia Patricia Ortega-Moya, Julia Nicolay-Maneru, Daria Maniero, Elena Resina, Roberto Penagini, Matteo Ghisa, Óscar Nantes-Castillejo, Ángel Arias, Cecilio Santander, Alfredo J LucendoBackground:
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.