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Regardless of a prior history of swallowed topical corticosteroids, dupilumab was proven to be an effective treatment in patients with eosinophilic esophagitis.
Patients with eosinophilic esophagitis (EoE) receiving dupilumab 300 mg once a week had sustained improvements in histologic, endoscopic, and symptomatic aspects of EoE up to 52 weeks, regardless of prior swallowed topical corticosteroids usage, or inadequate steroid response, intolerance to steroids, or contraindication to steroids, according to data presented at Digestive Disease Week (DDW) 2023.1
“EoE is a chronic and progressive disease with substantial impact on quality of life,” wrote Arjan Bredenoord, MD, PhD, affiliated with Amsterdam UMC, University of Amsterdam, and colleagues. “Swallowed topical corticosteroids are a treatment option for EoE; however, they are associated with side effects and some patients may not respond.”
Dupilumab, an approved treatment of EoE in both the United States and Europe, has shown improvements in endoscopic, symptomatic, and histologic features after 24 weeks of treatment. Based on those findings, investigators evaluated the long-term effects of dupilumab on these symptoms in this patient population up to 52 weeks.
In Part B of the study, patients received dupilumab 300 mg or placebo weekly for 24 weeks. Those who completed Part B were eligible to participate in Part C, which continued for an additional 28 weeks. Patients were categorized as with or without prior corticosteroid use and with or without prior inadequate response, intolerance, or contraindication to corticosteroids at the screening visit.
The percentage of patients able to achieve ≤6 eosinophils according to high-power field (eos/hpf), mean change in Endoscopic Reference Score (EREFS), absolute change in the Dysphagia Symptom Questionnaire (DSQ) score, and Histologic Scoring System (HSS) grade/stage scores were evaluated throughout the study.
In Part B, 80 patients were treated with dupilumab and 79 received the placebo. In Part C, 74 patients continued to receive dupilumab and 37 switched from the placebo to dupilumab. Of the patients in Part C, 78 of the 111 had a prior history of corticosteroid usage and 55 were classified as having prior inadequate response, intolerance, or contraindication to swallowed topical corticosteroids.
Regardless of a prior history of swallowed topical corticosteroids, dupilumab was proven to be an effective treatment in this patient population. At the 24-week mark, dupilumab-treated patients compared with placebo achieved ≤6 eos/hpf in the prior corticosteroid use category in 69% vs 7% of patients, respectively, and 57% vs 0% of those without prior steroid exposure. The DSQ score changes were -27.3 (-15.8) vs -13.6 (12.5) and -23.1 (15.6) vs -19.6 (15.0), respectively.
In Part C, dupilumab treatment continued to improve in the proportion of those obtaining ≤6 eos/hpf (prior steroid use: 86%, without a history of steroids: 81%) and DSQ score changes (-31.4 [15.8], -27.7 [14.6], respectively). Those who switched from placebo to dupilumab also improved at week 52 in the proportion of patients achieving ≤6 eos/hpf (prior steroid use: 70%, without a history of steroids 60%) and DSQ score (-26.1 [12.6], -29.9 [8.4], respectively).
At week 52, the EREFS and HSS grade/stage scores continued to improve or were maintained in patients receiving dupilumab treatment and improved in those who switched to dupilumab. These results were comparable in patients with and without prior inadequate response, intolerance, or contraindication to swallowed topical corticosteroids.