Lessons learned: real-world effectiveness of dupilumab in patients with eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus. Dupilumab, an IL-4/IL-13 inhibitor, was approved for EoE in 2022, but real-world data remain limited. We evaluated its effectiveness in a single tertiary care center uninvolved in prior clinical trials. We conducted a retrospective cohort study of adults (≥18 years) with confirmed EoE (≥15 eos/hpf) who initiated dupilumab therapy between 1/2022 and 10/2024 and evaluated symptom burden, endoscopic severity, histologic activity, as well as adverse events. Ultimately, 44 patients were included with significant decreases in clinical symptom and endoscopic scoring. Peak eosinophil counts declined by a median of 47.5 eos/hpf. Histologic remission occurred in 76.9% at follow-up 1 and maintained in 72.7% at follow-up 2. About 15.9% of patients reported AEs and 9.1% discontinued therapy. These findings are consistent with the clinical trial and recent observational data, supporting dupilumab's effectiveness and generalizability in real-world practice.