Introduction Eosinophilic esophagitis (EoE) is a chronic immune-mediated oesophagal disease in children that causes feeding difficulty, vomiting, abdominal pain, dysphagia, and poor quality of life. Standard therapy often includes proton-pump inhibitors and swallowed topical corticosteroids (STCs).
Introduction
Eosinophilic esophagitis (EoE) is a chronic immune-mediated oesophagal disease in children that causes feeding difficulty, vomiting, abdominal pain, dysphagia, and poor quality of life. Standard therapy often includes proton-pump inhibitors and swallowed topical corticosteroids (STCs). However, many children either do not respond adequately, cannot tolerate STCs, or have contraindications to their use. This creates an important therapeutic gap, especially in younger children with persistent inflammation and risk of long-term oesophagal remodelling.
Problem statement
The key clinical question is whether dupilumab remains effective in children with EoE who have already used STCs, particularly those with inadequate response, intolerance, or contraindication (IRIC) to steroid therapy.
Summary
This subgroup analysis from the phase 3 EoE KIDS study evaluated children aged 1–11 years with EoE not responsive to proton-pump inhibitors. Among 102 patients, 80% had prior STC use and 58% had prior IRIC to STCs. At week 16, higher-exposure dupilumab achieved histologic remission in about 61% of children with prior STC exposure and in a similar proportion of those with prior IRIC, compared with 0% on placebo. Improvements in endoscopic and histologic secondary outcomes paralleled these findings. Benefits were maintained through week 52, and children switched from placebo to dupilumab also improved. Lower-exposure dupilumab showed similar but generally smaller responses. Safety was consistent with the known dupilumab profile. Overall, this study supports dupilumab as an effective steroid-sparing option for children with difficult-to-treat EoE.
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