ramaiah medical college Bangalore, Karnataka, India
Ashish Sivaratri, 1, Ananya Prasad, 2, Vinay Chandramouli Bellur, 3, Omar Oudit, DO4, Aditya Singh, 5, Deepak Bhat, MBBS6, Shradha Chervittara Karaveetil, 2, Rishikesh R. Magaji, 7, Trisha Chandra Mohan, 7, Ashwin Kemtur, 8, Prakriti Ramamurthy, MBBS, MD9, Sravani Bhavanam, 10, Vikram Chandramouli Bellur, MBBS11 1Bangalore Medical College, Bangalore, Karnataka, India; 2ramaiah medical college, Bangalore, Karnataka, India; 3Ramaiah medical college, Bangalore, Karnataka, India; 4Brookdale University Hospital Medical Center, Brooklyn, NY; 5Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India; 6M. S Ramaiah Medical College, Bangalore North, Karnataka, India; 7BGS Global Institute of Medical Sciences, Bangalore, Karnataka, India; 8Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India; 9University of Massachusetts Chan Medical School - Baystate Health, Springfield, MA; 10Brookdale University Hospital Medical Center, Bangalore, Karnataka, India; 11Kasturba Medical College, Bengaluru, Karnataka, India Introduction: Eosinophilic esophagitis (EE) is defined as a chronic, immune mediated, esophageal inflammation characterised histologically by eosinophilic infiltration. Dupilumab (DPB), an Interleukin 4 receptor alpha antagonist, which by its mechanism of action inhibits predominantly the humoral immunity, as well as reduces eosinophil recruitment. Various RCTs have been done in the past, substantiating the safety and efficacy of dupilumab vs. standard therapy previously in use. The Systematic review and meta-analysis conducted aims to further assess the safety and efficacy of Dupilumab in EE. Methods: The review conducted follows the PRISMA guidelines and major medical databases, which include PUBMED, Google Scholar and Science-Direct, were extensively searched using a comprehensive search term to identify and retrieve available articles. The articles that included the assessment of histological remission of EE following DPB therapy were included in the final analysis.
The data was analysed using the Meta, Metadata and the Metafor packages of R Studio. The pooled proportion of the histological remission(HR) of EE following DPB therapy was assessed as our primary outcome. The pooled reduction in mean change of the Eosinophilic Esophagitis Histologic Scoring System was considered as the secondary outcome.
The data was analysed using the Meta, Metadata and the Metafor packages of R Studio. The Inverse variance method was utilised to analyse the odds ratio. The I^2 test was used to assess the heterogeneity of the studies. Results: The study included a total of 10 trial groups between 2 different subgroups based on different dosage schedules of Dupilumab, i.e. 300 mg Weekly and 300 mg Biweekly. The pooled proportion of subjects having complete histological remission of EE was estimated to be 70%(0.70(0.63;0.77) , p < 0.01 , I^2 = 81%). The mean reduced change in EoEHSS following DPB therapy was estimated to be 0.95(0.54; 0.37, I^2 = 100% , p < 0.01) Discussion: Improvement in symptomatic scores and histological outcomes indicates that Dupilumab is an effective therapy in the treatment of Eosinophilic esophagitis and should be considered as an effective intervention. In future DPB trials and studies, further analysis of endoscopic outcomes and monitoring of the symptoms after starting dupilumab are recommended to measure the potential benefits of the therapy and assess outcomes.
Figure: Histological Remission in patients recieving Dupilumab
Figure: Mean Reduction of EoeEHSS score in patients recieving Dupilumab
Disclosures: Ashish Sivaratri indicated no relevant financial relationships. Ananya Prasad indicated no relevant financial relationships. Vinay Chandramouli Bellur indicated no relevant financial relationships. Omar Oudit indicated no relevant financial relationships. Aditya Singh indicated no relevant financial relationships. Deepak Bhat indicated no relevant financial relationships. Shradha Chervittara Karaveetil indicated no relevant financial relationships. Rishikesh R. Magaji indicated no relevant financial relationships. Trisha Chandra Mohan indicated no relevant financial relationships. Ashwin Kemtur indicated no relevant financial relationships. Prakriti Ramamurthy indicated no relevant financial relationships. Sravani Bhavanam indicated no relevant financial relationships. Vikram Chandramouli Bellur indicated no relevant financial relationships.
Ashish Sivaratri, 1, Ananya Prasad, 2, Vinay Chandramouli Bellur, 3, Omar Oudit, DO4, Aditya Singh, 5, Deepak Bhat, MBBS6, Shradha Chervittara Karaveetil, 2, Rishikesh R. Magaji, 7, Trisha Chandra Mohan, 7, Ashwin Kemtur, 8, Prakriti Ramamurthy, MBBS, MD9, Sravani Bhavanam, 10, Vikram Chandramouli Bellur, MBBS11. P2734 - Efficacy of Dupilumab Therapy in Eosinophilic Esophagitis: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
