Dupilumab in adolescent eosinophilic esophagitis: Experience with fibrostenosis and eosinophilic gastrointestinal disease with esophageal involvement

Abstract We evaluated patients aged 12–20 on dupilumab 300 mg weekly for treatment of eosinophilic esophagitis (EoE) who had ≥1 follow‐up endoscopy at a tertiary care pediatric hospital ( n = 18). Fifty percent had inflammatory EoE ( n = 9), 22% had fibrostenotic EoE ( n = 4), and 28% had non‐EoE eosinophilic gastrointestinal disease (EGID) with esophageal involvement ( n = 5). Ninety‐four percent discontinued topical corticosteroids (TCS) 2–4 weeks after starting dupilumab. Eighty‐nine percent of inflammatory EoE patients had histological response (<15 eosinophils/high‐powered field) after an average of 19.1 weeks. One hundred percent of patients with fibrostenotic disease exhibited histological response after 16.8 weeks. Of patients with non‐EoE EGID, 60% achieved esophageal histological response after an average of 40.1 weeks. In a small cohort, dupilumab was very effective for adolescent inflammatory and fibrostenotic EoE despite rapid weaning of TCS. Dupilumab was also somewhat effective for non‐EoE EGID with esophageal involvement; however, a longer duration of therapy was required.