S679 Efficacy of Dupilumab on Facilitated Food Introduction in Eosinophilic Esophagitis

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Introduction: Eosinophilic esophagitis (EoE) is a chronic, debilitating disease characterized by esophageal inflammation, eosinophilic infiltration, and dysphagia. Common foods like milk, egg, soy, and wheat often trigger EoE. Treatments include dietary avoidance, dupilumab, and off-label use of swallowed steroids or proton-pump-inhibitors. However, food elimination diets are difficult for patients and can affect adherence and quality of life. Patients and families seek simple and effective therapy that offer broader dietary options. This study investigates the potential role of dupilumab in facilitating introduction of EoE trigger foods. Methods: We conducted an open label pilot study involving 21 patients between the ages of 6 and 25 years with EoE triggered by milk, egg, soy, or wheat. Participants received dupilumab alongside standard EoE therapy and elimination of their specific EoE trigger food, followed by standardized food introduction over 12 months. Symptoms were assessed through daily patient and caregiver questionnaires. Each patient underwent 4 upper endoscopies with evaluation by histology, Endoscopy Reference Score (EREFS), and Functional Luminal Imaging Probe (FLIP) prior to and with every phase of food introduction. Results: No significant difference was found in patient reported symptom scores pre (SEM 0.07, n=16) and post food introduction (SEM 0.07, n=23) while on dupilumab (P=0.73). Similarly, caregiver reported symptom scores showed no significant difference pre (SEM 0.06, n=16) and post food introduction (SEM 0.07, n=23) while on dupilumab (P=0.36). Pre and post-food introduction endoscopies revealed no significant changes in eosinophil counts (Pre: SEM 0.40, n=18; Post: SEM 1.11, n=36; P= 0.10), EREFS (Pre: SEM 0.24, n=18; Post: SEM 0.11, n=36 ; P=0.09), or esophageal distensibility (Pre: SEM 0.45, n=12; Post: SEM 0.56, n=28; P=0.43). Conclusion: Dupilumab facilitated the reintroduction of EoE trigger foods without exacerbating symptoms or compromising histological and endoscopic outcomes. This therapy effectively controlled symptoms, preserved histologic integrity, and prevented endoscopic progression. By controlling disease while permitting a more liberal diet, dupilumab has the potential to reduce the burden of dietary restrictions, thereby enhancing the quality of life for patients with EoE.

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