P2807 - Monoclonal Antibodies' Efficacy on Dysphagia Symptoms and Histological Remission in Patients With Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis

Bisher Sawaf, MD¹, Mulham Alom, MD², Mohammad Al Hayek, MD³, Muhammed Elhadi, MD⁴, Shahem Abbarh, MD⁵, Yusuf Omar Hallak, MD⁶, Ahmad Kasem, MSc⁷, Mohammed S. Beshr, MBBS⁸, Elias Battikh, MD⁹, Amine Rakab, MD¹⁰, Wael Dahhan, MD¹¹
1University of Toledo Medical Center, Toledo, OH; 2Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL; 3Damascus University, Dimashq, Dimashq, Syria; 4College of Medicine, Korea University, Seongbuk, Seoul-t'ukpyolsi, Republic of Korea; 5Georgetown University MedStar Health, Baltimore, WA; 6The University of Toledo, Toledo, OH; 7David Geffen School of Medicine at UCLA, Los Angeles, CA; 8Sana’a University, Faculty of Medicine and Health Sciences, Sana'a, Hadramawt, Yemen; 9John H. Stroger, Jr. Hospital of Cook County, Toledo, OH; 10Division of Medical Education, Weill Cornell Medicine, Doha, Ad Dawhah, Qatar; 11Detroit Medical Center/Wayne State University, Detroit, MI

Introduction: Eosinophilic esophagitis (EoE) is an increasingly recognized cause of dysphagia unresponsive to anti-acid measures, leading to impaired quality of life, with a prevalence ranging from 0.5-1 case per 1,000. The pathophysiology of EoE is complex, driven primarily by eosinophils, T-cells, IL-4, IL-5, and IL-13. This network meta-analysis aims to compare the efficacy of monoclonal antibodies to placebo and to each other using indirect meta-analysis to evaluate improvements in dysphagia symptoms at weeks 12 and 24 and the achievement of histologic remission within 24 weeks

Methods: A comprehensive search of PubMed, Cochrane, Scopus, Web of Science, and ClinicalTrials.gov was conducted up to October 2024. Only RCTs were included, focusing on 4 different monoclonal antibodies: dupilumab, benralizumab, mepolizumab, and RPC4046. Outcomes were dysphagia symptoms and histological remission. Dysphagia symptoms were assessed using different scales. Therefore, we used standardized differences in means to compare their results. Histological remission was defined as a peak esophageal intraepithelial eosinophil count of ≤6 per HPF. Odds ratios (OR) with 95% confidence intervals (CI) were used to determine histological remission.

Results: We included 5 studies, with 1 study reporting 2 independent trials. Consequently, 6 RCTs comprising 631 patients were included in the final analysis. All RCTs compared monoclonal antibodies with a placebo, with 145 patients treated with dupilumab, 103 received benralizumab, 32 received mepolizumab, 34 received RPC4046, and 317 individuals assigned to the placebo group. At week 12, dupilumab had the highest decrease in dysphagia symptoms compared to placebo (SMD: -3.74; 95% CI: -4.65 to -2.82). In addition, dupilumab showed statistically significant improvement of dysphagia symptoms compared to other agents. At 24 weeks, dupilumab showed a significant reduction in dysphagia symptoms compared to placebo (SMD: -5.03; 95% CI: -5.61 to -4.44), while benralizumab had a higher rate of dysphagia symptoms compared to placebo (SMD: 1.52; 95% CI: 1.20 to 1.84). However, benralizumab achieved the highest statistically significant increase in histological remission compared to placebo (OR: 98.90; 95% CI: 37.79 to 258.80).

Discussion: Dupilumab showed the greatest improvement in dysphagia symptoms at both 12 and 24 weeks, while benralizumab was most effective in achieving histological remission. These results highlight the differing strengths of monoclonal antibodies in treating EoE.


Figure: Figure 1 A, B & C - Network plots showing dysphagia symptoms reduction at weeks 12 & 24 as well as histological remission at week 24.


Figure: Figure 2 - Table showing the comparison of the results between the 4 different monoclonal antibodies as compared to placebo

Disclosures:
Bisher Sawaf indicated no relevant financial relationships.
Mulham Alom indicated no relevant financial relationships.
Mohammad Al Hayek indicated no relevant financial relationships.
Muhammed Elhadi indicated no relevant financial relationships.
Shahem Abbarh indicated no relevant financial relationships.
Yusuf Omar Hallak indicated no relevant financial relationships.
Ahmad Kasem indicated no relevant financial relationships.
Mohammed Beshr indicated no relevant financial relationships.
Elias Battikh indicated no relevant financial relationships.
Amine Rakab indicated no relevant financial relationships.
Wael Dahhan indicated no relevant financial relationships.

Bisher Sawaf, MD¹, Mulham Alom, MD², Mohammad Al Hayek, MD³, Muhammed Elhadi, MD⁴, Shahem Abbarh, MD⁵, Yusuf Omar Hallak, MD⁶, Ahmad Kasem, MSc⁷, Mohammed S. Beshr, MBBS⁸, Elias Battikh, MD⁹, Amine Rakab, MD¹⁰, Wael Dahhan, MD¹¹. P2807 - Monoclonal Antibodies' Efficacy on Dysphagia Symptoms and Histological Remission in Patients With Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.