Solidifying Dupilumab’s Role in Eosinophilic Esophagitis Care, With Evan Dellon, MD, MPH

New data presented at American College of Gastroenterology (ACG)’s 2025 Annual Scientific Meeting are solidifying dupilumab (Dupixent)’s role in eosinophilic esophagitis (EoE) care, spotlighting sustained reductions in dysphagia and odynophagia as well as endoscopic features of the disease.

Findings from the post-hoc analysis of LIBERTY EoE TREET and the pooled analysis of LIBERTY EoE TREET and EoE KIDS were presented by Evan Dellon, MD, MPH, a professor of medicine and adjunct professor of epidemiology at the University of North Carolina School of Medicine in Chapel Hill.

Dysphagia and Odynophagia in LIBERTY EoE TREET

LIBERTY EoE TREET data were pooled from patients ≥12 years of age treated with dupilumab qw or placebo for 24 weeks in Parts A and B of the trial who continued to Part C and received dupilumab qw to week 52. The number of days without dysphagia and number of days without odynophagia over a 14-day period were analyzed at baseline and every 2 weeks to week 52. The proportion of patients with 0 days of dysphagia or 0 days of odynophagia over each 14-day period was also analyzed.

At baseline, all patients reported dysphagia and 95% and 88% of patients who received dupilumab and placebo, respectively, reported odynophagia. At week 24, the mean number of days without dysphagia was greater in patients on dupilumab than placebo (8.7; 95% CI, 7.8-9.5 vs 5.5; 95% CI, 4.2-6.7; P <.0001). The mean number of days without odynophagia was also greater in patients on dupilumab versus placebo (10.1; 95% CI, 9.3-10.8 vs 6.8; 95% CI, 5.5-8.1; P <.0001) at week 24.

“Over the 24 weeks, compared to placebo, the number of dysphagia free days significantly increased with the dupilumab treatment, and that's a concept that I think is easy to convey to patients,” Dellon explained to HCPLive.

At week 52, the mean number of days without dysphagia and without odynophagia increased in patients switching from placebo to dupilumab (dysphagia 8.6; 95% CI, 7.2-10.0 and odynophagia 8.9; 95% CI, 7.4-10.4) and was maintained in patients continuing dupilumab (9.4; 95% CI, 8.4-10.4 and 10.6; 95% CI, 9.9-11.4). At week 24, greater proportions of dupilumab-treated patients had 0 days of dysphagia and 0 days of odynophagia over a 14-day period.

Endoscopic EoE Improvements in LIBERTY EoE TREET and EoE KIDS

The analysis included patients from Part A of EoE KIDS randomized to weight-tiered, higher-exposure dupilumab or placebo for 16 weeks, and patients from Parts A/B of LIBERTY EoE TREET randomized to weekly dupilumab 300 mg or placebo for 24 weeks.

Endoscopic Reference Score (EREFS) measuring the severity of edema, rings, exudates, furrows, and strictures was based on the worst observed region calculated using the highest score for each feature from either the proximal or distal esophagus. EREFS total and individual feature scores, and the proportion of patients with scores of 0 in each feature were assessed at baseline and week 16 or 24 based on the end of each study’s double-blind treatment period.

“This was looking at endoscopic findings and endoscopic severity, particularly as measured by the EREFS, and that's actually something in the guidelines that's been emphasized, where everybody who's doing an endoscopy for suspected EoE or for known EoE that you're following, you really should be calculating the score,” Dellon said.

In the total pooled cohort, 159 patients received dupilumab and 152 received placebo. Investigators noted baseline characteristics were generally comparable between the groups.

At weeks 16 and 24, results showed EREFS total score was reduced with dupilumab versus placebo (1.5; 95% CI, 1.3-1.8 vs 3.9; 95% CI, 3.6-4.2; P <.0001), as were scores for each feature. The proportion of patients scoring 0 for a given feature increased with dupilumab treatment:

• Edema: 44.8 vs 13.0%
• Rings: 57.7 vs 44.2%
• Exudates 89.5 vs 33.8%
• Furrows 68.5 vs 9.1%
• Strictures 93.7 vs 79.2%

Editors’ note: Dellon reports disclosures with AbbVie, Alfasigma, Amgen, AstraZeneca, Ferring, GSK, Phathom, Regeneron Pharmaceuticals, Sanofi, Shire/Takeda,Target RWE, and others.

References

1. Dellon ES, Gupta M, Chehade M, et al. Sustained Treatment Response With Dupilumab in Dysphagia and Odynophagia in Adults and Adolescents With Eosinophilic Esophagitis: Post-Hoc Analysis of the LIBERTY EoE TREET Study up to 52 Weeks. Presented at the American College of Gastroenterology (ACG)’s 2025 Annual Scientific Meeting. Phoenix, Arizona. October 27-29, 2025.

2. Dellon ES, Chehade M, Gonsalves NP, et al. Dupilumab Improves Endoscopic Features of Eosinophilic Esophagitis (Edema, Rings, Exudates, Furrows, and Strictures): Pooled Analysis from 2 Phase 3 Studies (EoE KIDS and LIBERTY EoE TREET). Presented at the American College of Gastroenterology (ACG)’s 2025 Annual Scientific Meeting. Phoenix, Arizona. October 27-29, 2025.