Pediatric patients with eosinophilic esophagitis have shown improvements when taking dupilumab since FDA approval in 2020.
Approved by the FDA in 2020 for patients 12 years of age and over, dupilumab, a monoclonal antibody against interleukin-4 receptor, has shown improvements in various histopathological and clinical metrics in pediatric eosinophilic esophagitis (EoE).
The study included 14 pediatric patients with EoE 4 to 19 years of age, whose esophageal biopsies were analyzed before and after dupilumab treatment. Histologic remission was defined by a peak eosinophil count (PEC) of less than 15 on follow-up biopsy. The biopsies were assessed using both traditional pathologist analysis and a validated AI model (Aiforia Technologies) for quantitative analysis of histopathologic features. The primary endpoints evaluated were PEC, EoE histology score (EoE-HSS), and improvements in basal zone hyperplasia (BZH) and dilated intercellular spaces (DIS). Secondary endpoints included lymphocyte counts and correlation of histologic changes with endoscopic reference scores (EREFS).
Of the 14 patients, 10 achieved histologic remission, showing a median decrease of 79.3% in PEC by AI analysis and 93.4% in the average eosinophil count per 0.24mm². Improvements were also observed in BZH (56.7%) and DIS (45.6%) in those who achieved remission. Additionally, a 30.3% decrease in peak lymphocyte count was noted in patients in remission, while those not in remission showed a 20.4% increase. Correlation analysis for all patients indicated a moderate correlation between EREFS changes and AI PEC changes, and a weaker correlation between EREFS changes and DIS AI changes.
The study confirms that dupilumab improves EoE-HSS findings in pediatric patients, with AI-based quantitative assessments providing results comparable to traditional pathologist evaluations. These findings highlight the potential of dupilumab as an effective treatment for EoE, offering a promising option for improving patient outcomes.
Medical writing support was provided by Federica Angius.
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