TOPLINE

Dupilumab was associated with histologic remission and improvements in endoscopic parameters among children and adolescents with eosinophilic oesophagitis who had predominantly not responded to standard treatments.

METHODOLOGY

• Researchers conducted a retrospective observational study including 51 paediatric patients with eosinophilic oesophagitis (median age at diagnosis, 8.9 years; 70.6% boys) treated with dupilumab across 13 Spanish hospitals from May 2022 to February 2025. 
• Most patients had previously received proton pump inhibitors (88.2%), swallowed topical corticosteroids (84.3%), and elimination diets (70.6%); 45.1% had received combination therapy. 
• Dupilumab treatment was prescribed for refractory eosinophilic oesophagitis in 88.2% of patients and for concomitant atopic disease in 11.8% of patients. The first follow-up endoscopy occurred at a median of 22 weeks; 19 patients completed a subsequent endoscopy at a median of 56 weeks. 
• The main outcome was histologic remission, defined as fewer than 15 eosinophils per high-power field (eos/hpf) across all oesophageal biopsy samples; deep remission required five or fewer eos/hpf. 
• The severity of symptoms was assessed using the Pediatric Eosinophilic Esophagitis Symptom Score version 2.0, and endoscopic response was measured using the endoscopic reference score. 

TAKEAWAY

• Among 45 patients with active histologic disease at baseline, 66.7% achieved histologic remission at the first follow-up, and among the 19 patients evaluated at the final follow-up, 78.9% achieved histologic remission. 
• Deep histologic remission occurred in 55.6% of patients at the first follow-up and 63.2% at the final follow-up. The mean peak eosinophil count declined from 67 at baseline to 10 at the initial follow-up and 8.5 at the final evaluation (P < .001). 
• Dupilumab treatment was linked to endoscopic improvement, with a mean total endoscopic reference score decreasing from baseline at both initial and final follow-ups (P < .01 for both); 51.1% of patients had a normal endoscopy reported at the initial follow-up. 
• Adverse events occurred in 35.3% of patients, mostly injection-site pain and reactions, with no treatment discontinuations due to adverse events. Conjunctivitis, serious adverse events, and laboratory abnormalities were not reported. 

IN PRACTICE

"[D]upilumab was effective and well tolerated in this multicentre real-world cohort of paediatric EoE [eosinophilic oesophagitis], with sustained improvement across key disease domains. Larger prospective studies should define predictors of response, optimal duration before response assessment, treatment de-escalation strategies and the long-term impact on esophageal remodelling," the authors concluded.

SOURCE

The study was led by Ruth García-Romero, Hospital Miguel Servet, Zaragoza, Spain. It was published online on September 17, 2026, in Digestive and Liver Disease.

LIMITATIONS

The study was limited by its retrospective design, the absence of a control group, and heterogeneity in medication doses and concurrent therapies, inconsistent follow-up intervals, and incomplete endoscopic data, which made it hard to determine the cause-and-effect relationship and may have introduced bias.

DISCLOSURES

This study did not receive any specific funding. Three authors reported receiving consulting fees and/or speaker honoraria from various pharmaceutical, biopharmaceutical, and nutrition product companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.