The Index of Severity for Eosinophilic Esophagitis Helps Predict Treatment Response to Dupilumab

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease characterized by esophageal dysfunction due to eosinophilic infiltration.¹ Evidence suggests a progression from inflammatory to fibrostenotic disease in many patients, but no consensus exists on how best to monitor the clinical trajectory of EoE. This has led to highly variable clinical practicez that often diverge from clinical guidelines.² In other gastrointestinal diseases with a treat-to-target approaches, clinical tools have been developed to monitor disease activity, but analogous tools had been lacking for EoE.^3,4 Recently, a scoring system was devised for clinical assessment of EoE, the Index of Severity for Eosinophilic Esophagitis (I-SEE), that divides key disease features into 3 categories: symptoms and complications, inflammatory features, and fibrostenotic features.⁵ Since its inception, several studies have explored the relationship between I-SEE scores and disease response, finding that I-SEE accurately gauged disease severity and treatment response.^6-8 It is currently uncertain if changes in I-SEE scores are associated with response to dupilumab treatment. Therefore, the goals of our study were to determine if I-SEE scores were associated with traditional response metrics when using dupilumab therapy and whether response differences to dupilumab exist based on I-SEE categories within an EoE population.