Clinical and Translational Allergy, Journal Year: 2024, Volume and Issue: 14(1)

Published: Jan. 1, 2024

Dupilumab is a human monoclonal antibody against interleukin-4 receptor alpha subunit. an approved treatment for inducing remission of eosinophilic esophagitis (EoE).1 EoE histologic with dupilumab has only been demonstrated in patients after at least 12 weeks treatment.2-6 Current guidelines recommend waiting re-evaluation until 20–24 dupilumab.1 It unknown if increasing length improves its efficacy. Because requires invasive biopsies, and important to prevent progressive esophageal damage, research investigating the effects on prior warranted. We conducted retrospective study single medical clinic. The electronic record was searched between 2017 2023 using International Classifications Disease, 10th revision code K20.0 esophagitis. excluded who had (1) never started dupilumab; (2) no confirmation defined by ≥ 15 eos/hpf; or (3) while dupilumab. Histologic evaluation assessed 2 biopsies each proximal, middle, distal esophagus. Endpoints were peak eosinophil counts (eosinophils per high-power field; eos/hpf), endoscopic reference scores (EREFS), composite symptom score which (dysphagia, food impaction/choking, regurgitation/vomiting, heartburn/chest pain, abdominal pain) graded (0 = absent, 1 mild, moderate, 3 severe) summed. This deemed exempt from institutional review board approval WCG IRB. From record, 658 identified, 534 initiated dupilumab, 6 did not have EoE, 39 repeat initiation. Therefore, 79 included this study. median age 27.6 years (Q1 Q3, 21.8–36.1), 48 (60.8%) male, (15.2%) pediatric (Table 1). Sixty (75.9%) atopic comorbidity, including allergic rhinitis (43 patients, 54.4%), asthma (27 34.2%), dermatitis (13 16.5%), allergies (30 38.0%). Patients 22.7 16–26.7). Dosages 300 mg every week (71 89.9%), other loading dose 600 (7 8.9%), 200 400 (1 patient, 1.3%). Of 0–12 weeks. 5.5 4–6), significantly decreased 0 0–1; Wilcoxon matched-pairs signed rank test, p 0.000488) Median 44.5 eos/hpf 32.5–53.5) baseline 0–15.5; 0.000977) Endoscopic available (19%) our cohort. In weeks, EREFS decrease (median, 2; Q1 1–4) versus 0; 0–1.5; 0.25). However, change also insignificant 12–24 (p 0.13), greater than 24 0.25), suggesting insignificance may be due low n. induce clinical benefit treatment. There significant differences changes 0.1350), count 0.0746); 0.8771) 12, 12–24, terms response, 9 (75%) histologically responsive group, 28 (73.7%) 26 (89.7%) longer group. difference proportion response groups (Fisher's exact 0.2569). Subanalysis 7 >1 evaluations summarized Figure 1. Three unresponsive early timepoints (Patient 4 Patient 5 weeks) without addition combination therapy. contrast, remained over therapy omeprazole mometasone, respectively. their Our subanalysis suggests that certain are EGDs respond later timepoints. Further needed predict EGDs. Swimmer plot multiple * indicates mometasone 1.6 twice daily. ** 20 once *** mg, as opposed week. conclusion, induced before treatment, there clinical, histologic, 2–24 beneficial identify earlier previous indicate.1 should investigate appropriate window performed. Twan Sia: Conceptualization (equal); data curation formal analysis investigation methodology validation visualization writing—original draft writing—review editing (equal). Amanda Miller: Data Leeon Bacchus: Jennie Young: Aditya P. Narayan: Rachel Solecki: Investigation Jerry Fu: Yuting Jiang: Raisa Khuda: Stanley Liu: Kathleen Love: Shibani Mallik: Amina Sara Matmatte: Paige McDonald: Tanvi Telukunta: Alyssa Roby: Saad Shami: Michelle Zheng: Madison Headen: John Leung: project administration resources supervision None. consultant Devine; Millimet Branch Professional Education; Sanofi; Huron Consulting Services LLC; Takeda; Ribon Therapeutics; Tegus; Slingshot; Guidepoint; Cowen; AstraZeneca; Regeneron; AbbVie. None authors relevant conflicts interests disclose. received specific grant any funding agency public, commercial, not-for-profit sectors. All de-identified materials stored HIPPA-compliant, password-protected, cloud-based storage. Access these files will provided upon reasonable request corresponding author, Leung.

Language: Английский