SynthesisInternational archives of allergy and immunology2026
Efficacy and Safety of Dupilumab in Eosinophilic Esophagitis: A Systematic Review and Meta-Analysis.
Synthesis in International archives of allergy and immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
introductionEosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus driven by type-2 inflammation. Dupilumab, a monoclonal antibody targeting the IL-4Ra subunit shared by the IL-4 and IL-13 receptor complexes, has recently emerged as a targeted biologic therapy for EoE. This systematic review evaluates the evidence for dupilumab in EoE across pediatric and adult populations, focusing on efficacy, safety, and symptom improvement.
methodsMEDLINE and Embase were searched from inception to June 30, 2025. Eligible studies included randomized controlled trials (RCTs), cohort studies, case-control studies, and case reports reporting dupilumab use in confirmed EoE. Study screening and quality assessment were performed in duplicate. Data on demographics, atopic comorbidities, dosing regimens, histologic outcomes, symptom improvement, and adverse events were extracted and summarized descriptively.
resultsNineteen studies (three randomized trials, nine cohorts, seven case reports) comprising 760 patients were included. Dupilumab was most commonly initiated following inadequate response or intolerance to proton pump inhibitors, swallowed corticosteroids, or dietary therapy. Across RCTs, histologic remission (≤15 eos/hpf) occurred in 60%-84% of dupilumab-treated patients versus <10% of placebo-treated patients. Cohort studies demonstrated comparable rates (68%-93%), with pediatric cohorts showing particularly robust responses (up to 90% remission). Meta-analysis using a random-effects logit model demonstrated a pooled histologic remission rate of 75.5% (95% CI: 67.4-82.1%) and a symptom improvement rate of 84.1% (95% CI: 77.8-88.9%).
conclusionsDupilumab represents a promising therapeutic option, particularly for patients with inadequate response to proton pump inhibitor therapy, including those unable to maintain dietary restrictions. Future research should focus on predictors of response, durability of remission beyond 1 year, and comparative effectiveness relative to other therapies.
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