SUCCESSFUL TREATMENT OF REFRACTORY PEDIATRIC EOSINOPHILIC ESOPHAGITIS WITH DUPILUMAB

Abstract

<h3>Introduction</h3> Eosinophilic esophagitis (EoE) is a chronic T-helper 2 (Th2) antigen driven disease characterized by eosinophilic infiltrates in the esophageal mucosa. Currently, there are no therapies approved by the United States Food and Drug Administration (FDA) for EoE in patients under twelve years of age. Expert guidance recommends the use of proton pump inhibitors (PPI), swallowed corticosteroids, elimination diets, and esophageal dilation<i>.</i> However, these interventions do not ameliorate symptoms and eosinophilic inflammation in all cases. Herein, we describe the successful treatment of a ten-year-old patient with EoE refractory to guideline-directed therapy with dupilumab. <h3>Case Description</h3> Our patient is a ten-year-old male with failure to thrive and EoE refractory to dietary change, swallowed corticosteroids, and PPI therapy. Due to the severity of his disease, the patient was initiated on monthly dupilumab injections. Following 6 months of dupilumab therapy (300mg subcutaneously Q4 weeks) he experienced endoscopic and histologic remission (0 eos/hpf). He remained in clinical and histologic remission more than 3 months after milk was reintroduced into the diet. <h3>Discussion</h3> We report the histologic, endoscopic, and symptomatic improvement in refractory pediatric EoE following treatment with monthly dupilumab in a ten-year-old male. Our findings suggest that the use of dupilumab can be extended to the pediatric population. Additionally, our case suggests that monthly injections, rather than the weekly injections utilized for adult EoE treatment, may be sufficient. Lastly, dupilumab also allowed for the liberalization of our patient's diet with sustained histologic and endoscopic resolution. In summary, dupilumab successfully treated refractory EoE and sustained disease remission despite allergen reintroduction.