Dupilumab Improves Esophageal Distensibility in EoE: REMODEL Trial

Dupilumab significantly improved esophageal distensibility and endoscopic features vs placebo in adults with active eosinophilic esophagitis (EoE) at 24 weeks, according to results from the phase 4 REMODEL trial presented at the American College of Gastroenterology (ACG) 2026 Annual Scientific Meeting in Nashville, Tennessee.1

Evan Dellon, MD, MPH, of the University of North Carolina School of Medicine, presented a subgroup analysis showing that the largest gains in esophageal diameter occurred in patients who began the study with a narrower esophagus.1

In an interview with HCPLive, Dellon explained that EoE typically progresses from inflammation to fibrostenosis over time. That remodeling produces rings, strictures, and diffuse narrowing, which drive food impactions and the need for dilation. Earlier approval studies showed that dupilumab improves histologic, symptomatic, and endoscopic outcomes.2 REMODEL was designed to test whether the drug could also reverse structural changes.

REMODEL Trial Design and Esophageal Distensibility Results

REMODEL randomized 69 adults in a 2:1 ratio to dupilumab 300 mg once weekly (n = 46) or placebo (n = 23).1,3 The primary end point was the absolute change in esophageal distensibility plateau (DP) at week 24, measured by endoluminal functional lumen imaging probe (EndoFLIP). Dellon noted that patients could not undergo dilation during the study, which isolated the effect of the drug itself.

At week 24, DP increased by a least squares mean of 1.28 mm with dupilumab vs −0.01 mm with placebo (difference, 1.30 mm; 95% CI, 0.31 to 2.29; P <.05).1 Dellon said the gain may sound modest, but it is roughly what a single dilation session achieves in a patient with EoE.

The benefit was concentrated in patients with a baseline DP < 17 mm, a threshold Dellon described as marking risk for food impaction (difference, 2.21 mm; 95% CI, 0.78-3.63; nominal P = .002). In patients at ≥ 17 mm, the difference was 0.38 mm (95% CI, −1.01 to 1.78; nominal P = .59). Dellon said these patients already had a normal caliber and had little room to improve.1

Endoscopic Improvements and Safety With Dupilumab in EoE

Dupilumab reduced the EoE Endoscopic Reference Score (EREFS) total score vs placebo (difference, −4.96; 95% CI, −6.06 to −3.85; P <.001), including the fibrostenotic subscore (difference, −0.78; 95% CI, −1.43 to −0.14; nominal P = .02). Endoscopic improvement was consistent in both DP subgroups (differences, −5.13 and −4.90; both nominal P <.001). Investigators reported that the endoscopic gains at week 24 were driven largely by inflammatory features, and no new safety signals were identified.1

Dellon noted that 44% of participants had undergone dilation before enrollment, yet none required dilation during the first 6 months. A 2-year open-label extension, in which all participants receive dupilumab, will assess whether caliber continues to improve without dilation. Dellon said additional data on epithelial barrier function from REMODEL are expected at an upcoming European gastroenterology meeting.

Dellon acknowledged that EndoFLIP remains largely a research tool in EoE. He said clinicians can still estimate esophageal caliber in practice by noting whether the endoscope passes, or by sizing with balloon dilators or progressively larger bougies. In his view, for patients without a critical stricture, the REMODEL data may support a conversation about starting treatment before deciding whether to dilate.

Editor's note: Dellon reports relevant disclosures with AbbVie, Alfasigma, AstraZeneca, Ferring, GSK, Phathom, Regeneron Pharmaceuticals Inc., Sanofi, Shire/Takeda, Target RWE, and others.

References

1. Dellon ES, et al. Dupilumab improves esophageal distensibility and endoscopic features in patients with eosinophilic esophagitis: 24-week results from the phase 4 REMODEL trial analyzed overall and by baseline distensibility plateau. Presented at: American College of Gastroenterology 2026 Annual Scientific Meeting; October 9-14, 2026; Nashville, TN.

2. Dellon ES, Rothenberg ME, Collins MH, et al. Dupilumab in adults and adolescents with eosinophilic esophagitis. N Engl J Med. 2022;387(25):2317-2330. doi:10.1056/NEJMoa2205982

3. ClinicalTrials.gov identifier: NCT06101095. Accessed October 12, 2026. https://clinicaltrials.gov/study/NCT06101095