Efficacy of Dupilumab for Induction and Maintenance of Remission in Patients With Eosinophilic Gastritis, Enteritis, and Colitis With Concomitant Eosinophilic Esophagitis

BACKGROUND: Eosinophilic gastrointestinal diseases (EGIDs) are chronic, immune-mediated diseases characterized by pathological infiltration of eosinophils in the gut. EGIDs include eosinophilic esophagitis (EoE), gastritis (EoG), enteritis (EoN), and colitis (EoC). There are no approved drugs for non-EoE EGIDs due to a lack of evidence. AIMS AND METHODS: In this case series, we report the efficacy of dupilumab-prescribed for concomitant EoE-for the induction and maintenance of remission of non-EoE EGIDs. Adult patients (> 18 years) diagnosed with non-EoE EGIDs and concomitant EoE who had been prescribed dupilumab 300 mg weekly were prospectively enrolled. Outcome assessment was performed according to EGID-specific instruments when available (i.e., peak eosinophil count, modified dysphagia questionnaire, Pisa EoE adaptation questionnaire, EoE and EoG endoscopic reference scores). RESULTS: Four patients were included. All were female and their age spanned 21-77 years at diagnosis. Two patients had EoE + EoG (case 1 and 2), one EoE + EoG + EoN (case 3), and one EoE + EoN + EoC (case 4). EoG presented with epigastric pain, while EoN and EoC presented with abdominal pain and diarrhea. Cases 1 and 2 achieved clinical, endoscopic, and histological remission with induction corticosteroid treatment, while case 3 did not, and case 4 developed steroid-related adverse events. When switched to dupilumab 300 mg weekly, cases 1, 2, and 3 achieved histological remission and sustained clinical remission up to 12-18 months from induction. In case 4, dupilumab achieved histologic remission and partial clinical response up to 16 months from induction. CONCLUSION: Dupilumab, prescribed for EoE, may be effective for the management of concomitant non-EoE EGIDs.