Eosinophilic esophagitis improves with dupilumab regardless of food elimination diets

Key takeaways:

• The impact of food elimination diets on medication previously was unknown.
• Absolute mean changes in Dysphagia Symptom Questionnaire scores among those who were and who were not on diets were comparable.

SAN DIEGO — Adolescents and adults with eosinophilic esophagitis improved with dupilumab regardless of whether they were practicing food elimination diets during treatment, according to a poster presented here.

The impact of concurrent food elimination diets on medication efficacy previously was unknown, Antonella Cianferoni, MD, PhD, associate professor of pediatrics, Perelman School of Medicine at the University of Pennsylvania, said at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress.

“EoE is a chronic, progressive disease driven in part by type 2 inflammation that damages the esophagus and impairs its function,” Cianferoni told Healio. “Food elimination diets are an established EoE treatment, but it is not known whether they impact the efficacy of medicines.”

Patients may see improvements in their underlying inflammation with elimination diets, she continued, but these diets can be burdensome to sustain in the long term.

“That said, this trial did not measure the efficacy of elimination diets in EoE, but rather the efficacy of dupilumab with or without the use of these diets,” Cianferoni said.

Among the 89 adolescents and adults who were on a food elimination diet for EoE at screening, 61.3% (95% CI, 42.2%-78.2%) of those on weekly 300 mg doses of dupilumab (Dupixent; Sanofi, Regeneron) and 3.4% (95% CI, 0.1%-17.8%) of those on placebo had a total of 6 or fewer eosinophils per high power field at week 24.

Percentages of patients who did not have a food elimination diet during treatment with 6 or fewer eosinophils per high power field at week 24 included 57.1% (95% CI, 42.2%-71.2%) of the treatment group and 8% (95% CI, 2.2-19.2) of the placebo group, which the researchers called comparable with those who maintained food elimination diets.

Absolute mean changes in Dysphagia Symptom Questionnaire scores at week 24 included –26.25 with treatment and –18.27 with placebo, both with a concurrent food elimination diet, and –21.43 with treatment and –10.39 with placebo, both with no food elimination diet, which the researchers also called comparable.

The diet and non-diet groups had similar improvements in Endoscopic Reference Scores and EoE Histologic Scoring System results at week 24 as well, the researchers continued.

Further, improvements in these endpoints persisted among the patients using dupilumab through 52 weeks of treatment regardless of whether they were on a food elimination diet. Patients who switched from placebo to dupilumab at week 24 saw similar improvements through 52 weeks, the researchers added.

“Endoscopic and histological measurements showed a significant difference (P < .0001) between dupilumab and placebo groups regardless of food elimination diet,” Cianferoni said. “In this post-hoc analysis, P values were derived by analysis of covariance model stratified by age group and use of proton pump inhibitors at randomization.”

Based on these findings, the researchers concluded that patients experienced histologic, symptomatic and endoscopic improvements in EoE with dupilumab regardless of their diets. In other words, Cianferoni said, patients who use dupilumab do not have to adjust their diets.

“At 6 months, dupilumab increased the proportion of patients who achieved histological disease remission, improved swallowing and reduced abnormal endoscopic findings and disease severity and extent at the microscopic level compared to placebo in patients irrespective of their food elimination diet,” Cianferoni said. “These improvements were sustained up to 1 year.”

Although the trial is complete, Cianferoni said, the researchers will continue to analyze the data for further insights.

“Additionally, a phase 4 study is ongoing to determine the long-term efficacy of dupilumab and its impact on esophageal remodeling in EoE,” Cianferoni said.