This protocol addresses patients with eosinophilic esophagitis who have completed an adequate initial anti-inflammatory trial and did not achieve the required clinical and histologic response endpoints.
Response to first-line therapy was assessed at 8–12 weeks by endoscopy with biopsies. The patient did not reach all three required response criteria: histologic response (esophageal eosinophil count <15 eos/hpf), endoscopic improvement (EREFS ≤2), and symptomatic improvement of esophageal dysfunction. Non-achievement of these targets triggers escalation to the next treatment line.
The prior regimen comprised one of the following: a high-dose proton pump inhibitor (PPI), swallowed topical corticosteroids (budesonide or fluticasone propionate), or an empiric food elimination diet beginning with a less-restrictive approach and escalated as needed. The required histologic, endoscopic, and symptomatic response targets were not met at the 8–12 week reassessment.
DOI: 10.14309/ajg.0000000000003194
We suggest dupilumab as a treatment for EoE in individuals 12 years of age or older who are nonresponsive to PPI therapy.
We suggest dupilumab as a treatment for EoE in pediatric patients (ages 1–11 years) who are nonresponsive to PPI therapy.
If there is nonresponse to pharmacologic treatment, dupilumab could be considered, and if there is nonresponse to dietary elimination, a more-restrictive diet could be considered or the patient could switch to pharmacologic options; clinical trials can also be considered for nonresponsive patients.
For dupilumab, the timing may range between 12 and 24 weeks based on clinical trial findings.
The coprimary endpoints were histologic remission, defined as ≤6 eos/hpf, and the absolute change from baseline in dysphagia frequency and severity, as measured by the validated Dysphagia Symptom Questionnaire.