Biological Therapy for Complicated Forms of Eosinophilic Esophagitis

Abstract

Aim: to evaluate the efficacy and safety of dupilumab, a biologic therapy, in the treatment of refractory eosinophilic esophagitis complicated by esophageal strictures and food impaction, in patients who have failed prior therapy with proton pump inhibitors and topical glucocorticosteroids. Materials and methods. In a prospective study conducted from July 2024 to February 2026, 19 patients (2 females, 17 males) aged 19 to 70 years with a previously confirmed diagnosis of eosinophilic esophagitis were administered dupilumab at a dose of 300 mg once weekly subcutaneously for 12 weeks. Indications for dupilumab administration included a complicated disease course (esophageal strictures and narrowing, esophageal dissection, recurrent episodes of acute food impaction) in the setting of resistance to prior therapy with topical glucocorticosteroids and/or proton pump inhibitors. Additional criteria for initiating biologic therapy included coexisting T2-associated diseases, such as bronchial asthma, chronic rhinosinusitis with nasal polyposis, and atopic dermatitis. All patients underwent assessment of dysphagia severity according to the Dysphagia Symptom Questionnaire (DSQ), calculation of the clinical and morphological disease activity index, esophagogastroduodenoscopy with esophageal biopsy (at least 6 biopsy specimens from the distal and middle/proximal esophagus), and histopathological examination of biopsy specimens both prior to treatment and at 12 weeks of therapy. Results. At 12 weeks of dupilumab therapy, complete resolution of dysphagia was observed in 9 (75 %) of 12 patients with dysphagia at baseline, and clinical remission (absence of any complaints) was achieved in 12 (63.2 %) of 19 patients. The mean DSQ score, reflecting dysphagia severity, decreased from 32.01 to 7.12 (p < 0.05). Endoscopic disease activity, as assessed by the EREхFS score, decreased from 5.0 [4.0; 7.0] to 1.0 [1.0; 3.0] points (p < 0.0001). Although the proportion of patients with strictures did not change significantly, an increase in esophageal diameter at the stricture site was observed (from 13.1 ± 5.8 mm to 16.1 ± 2.0 mm; p < 0.05). Histological remission (< 15 eosinophils per HPF, ×400) was achieved in 18 (94.7 %) of 19 patients. Adverse events included upper extremity joint pain (1 patient, 5.3 %), conjunctival dryness (2 patients, 10.5 %), and peripheral blood eosinophilia with elevated liver enzymes up to 3–4 times the upper limit of normal (1 patient, 5.3 %). Conclusions. Dupilumab therapy over 12 weeks leads to the achievement of clinical (63.2 %) and histological (94.7 %) remission in eosinophilic esophagitis.