P4892 - Efficacy and Safety of Dupilumab in the Treatment of Eosinophilic Esophagitis: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials With Subgroup Analysis by Dosage and Prior Steroid Use

Ashesh Das, MBBS¹, M. Rafiqul Islam, ², Sunaisha Addanki, MBBS³, Nitin Muralidharan, MBBS⁴, Rithvika Badugu, MBBS⁵, Rutvikkumar Jadvani, MBBS⁶, Rajkumar Adepu, MBBS⁷, Venkata Dileep Kumar Veldi, MBBS⁸, Jana Al Jnainati, MD⁹, Naga Sai Akhil Reddy Gogula, MBBS¹⁰, Dipanjan Chowdhury, MBBS¹¹, Sailesh I S. Kumar, MBBS¹², Kunal Gahlot, MBBS¹³, Sutirtha Mohanty, MBBS¹⁴, Aashwin Kaushal, MBBS¹⁵
1KPC Medical College and Hospital , Kolkata, India, Kolkata, West Bengal, India; 2Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh, Dhaka, Dhaka, Bangladesh; 3Gandhi Medical College & Hospital, Secunderabad, India, Hyderabad, Telangana, India; 4Chettinad Hospital & Research Institute, Chennai, Tamil Nadu, India; 5Gandhi Medical College & Hospital, New York, NY; 6Government Medical College, Surat, India, Surat, Gujarat, India; 7Kamineni Institute of Medical Sciences, Karimnagar, Telangana, India; 8Gayatri Vidya Parishad Institute of Health care and Medical Technology, Visakhapatnam, Andhra Pradesh, India; 9University of Milan–Bicocca: Universita degli Studi di Milano-Bicocca, Bergamo, Lombardia, Italy; 10Duke University, Durham, NC; 11IPGME&R and SSKM Hospital, Kolkata, West Bengal, India; 12Madras medical college, Birmingham, AL; 13Vardhman Mahavir Medical College and Safdarjung Hospital, Bhilwara, Rajasthan, India; 14Government Medical College Kozhikode, Bryan, TX; 15Government Medical College Amritsar, Amritsar, Punjab, India

Introduction: Eosinophilic Esophagitis (EoE) is a chronic immunologic disorder with limited therapeutic options available. Despite the symptomatic relief brought on by the steroids and dietary modifications, many patients continue to suffer. Biologics such as Dupilumab that target the IL-4/IL-13 pathway have shown great promise in the recent trials. This Systematic Review and Meta-Analysis evaluates the efficacy and the safety of Dupilumab in the treatment of EoE with using Subgroup Analysis by dosage and prior steroid use.

Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified Randomized Controlled Trials (RCTs) comparing dupilumab with placebo in EoE through March 2025. Data were analysed using R (4.4.3).Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random- or fixed-effects models were applied based on heterogeneity (Higgins’ I²). Statistical significance was set at p < 0.05. Risk of bias was assessed using RoB 2.0.

Results: Four RCTs (n = 844) showed that dupilumab significantly improved five key endpoints, with only a modest increase in mostly mild adverse events. Histologic remission (< 15 eos/hpf) was significantly higher with dupilumab (RR: 6.78; 95% CI: 3.39–13.58; p < 0.001; I² = 83.5%). Weekly dosing showed a benefit over longer intervals in fixed-effect models (χ² = 6.73; p = 0.0095) but not under random effects (p = 0.56), indicating comparable efficacy. Remission rates were unaffected by prior topical steroid use (χ² = 3.04; p = 0.22), supporting efficacy in steroid-refractory patients. Endoscopic severity (EREFS) improved significantly (MD: –2.01; 95% CI: –3.44 to –0.59; p = 0.0057; I² = 42.7%), with borderline subgroup interaction by dose and steroid history. Dysphagia improved by MD: –8.73 (95% CI: –12.40 to –5.05; p < 0.001; I² = 96.5%) without significant subgroup interaction. Quality-of-life changes were modest and statistically nonsignificant (MD: –0.12; p = 0.39; I² = 83%). Adverse events were slightly more frequent with dupilumab (RR: 1.15; 95% CI: 1.01–1.29; p = 0.028; I² = 51.4%), with no subgroup-specific differences.

Discussion: Regardless of dosage or steroid history, dupilumab exhibits robust and steady efficacy in EoE across histologic, endoscopic, and symptomatic outcomes. Subgroup interactions were negligible despite some heterogeneity. With only a slight increase in mild adverse events, Dupilumab stands out as a safe and highly effective biologic.


Figure: Figures Showing Forest Plots of QoL with Overall and Dose Subgroup, Dysphagia Symptoms Questionnaire with Overall and Prior STC Use Subgroup, Dysphagia Symptoms Questionnaire with Overall and Dose Subgroup, Long Term Safety with Overall and Dose Subgroup, Long Term Safety with Overall and Prior STC Use Subgroup, Histologic Remission with Overall and Dose Subgroup, Histologic Remission with Overall and Prior STC Use Subgroup, EREFS with Overall and Dose Subgroup, EREFS with Overall and Prior STC Use Subgroup


Figure: Prisma Flowchart

Disclosures:
Ashesh Das indicated no relevant financial relationships.
M. Rafiqul Islam indicated no relevant financial relationships.
Sunaisha Addanki indicated no relevant financial relationships.
Nitin Muralidharan indicated no relevant financial relationships.
Rithvika Badugu indicated no relevant financial relationships.
Rutvikkumar Jadvani indicated no relevant financial relationships.
Rajkumar Adepu indicated no relevant financial relationships.
Venkata Dileep Kumar Veldi indicated no relevant financial relationships.
Jana Al Jnainati indicated no relevant financial relationships.
Naga Sai Akhil Reddy Gogula indicated no relevant financial relationships.
Dipanjan Chowdhury indicated no relevant financial relationships.
Sailesh Kumar indicated no relevant financial relationships.
Kunal Gahlot indicated no relevant financial relationships.
Sutirtha Mohanty indicated no relevant financial relationships.
Aashwin Kaushal indicated no relevant financial relationships.

Ashesh Das, MBBS¹, M. Rafiqul Islam, ², Sunaisha Addanki, MBBS³, Nitin Muralidharan, MBBS⁴, Rithvika Badugu, MBBS⁵, Rutvikkumar Jadvani, MBBS⁶, Rajkumar Adepu, MBBS⁷, Venkata Dileep Kumar Veldi, MBBS⁸, Jana Al Jnainati, MD⁹, Naga Sai Akhil Reddy Gogula, MBBS¹⁰, Dipanjan Chowdhury, MBBS¹¹, Sailesh I S. Kumar, MBBS¹², Kunal Gahlot, MBBS¹³, Sutirtha Mohanty, MBBS¹⁴, Aashwin Kaushal, MBBS¹⁵. P4892 - Efficacy and Safety of Dupilumab in the Treatment of Eosinophilic Esophagitis: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials With Subgroup Analysis by Dosage and Prior Steroid Use, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.