Efficacy of Dupilumab in the Treatment of Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Chu, Szu-Hung; Chen, Jeng-Jung; Chen, Chung-Chu; Lei, Wei-Te; Lien, Chi-Hone; Weng, Shung-Long; Yeung, Chun-Yan; Liu, Lawrence Yu-Ming; Tai, Yu-Lin; Huang, Ya-Ning; Lin, Chien-Yu

doi:10.3390/life15020307

Open AccessSystematic Review

Efficacy of Dupilumab in the Treatment of Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

by

Szu-Hung Chu

^1,†,

Jeng-Jung Chen

^1,2,†,

Chung-Chu Chen

^3,4

,

Wei-Te Lei

^1,5,6,

Chi-Hone Lien

¹,

Shung-Long Weng

^2,5,7,

Chun-Yan Yeung

^1,5,

Lawrence Yu-Ming Liu

^3,5,

Yu-Lin Tai

¹

,

Ya-Ning Huang

^1,8

and

Chien-Yu Lin

^1,5,*

¹

Department of Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu 30070, Taiwan

²

Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan

³

Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan

⁴

Centers of Natural Science, Minghsin University of Science and Technology, Hsinchu 30401, Taiwan

⁵

Department of Medicine, MacKay Medical College, New Taipei 25245, Taiwan

⁶

Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan

⁷

Department of Obstetrics and Gynecology, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu 30070, Taiwan

⁸

College of Public Health, National Taiwan University, Taipei 10055, Taiwan

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Life 2025, 15(2), 307; https://doi.org/10.3390/life15020307

Submission received: 23 January 2025 / Revised: 13 February 2025 / Accepted: 14 February 2025 / Published: 17 February 2025

(This article belongs to the Special Issue Gastrointestinal Health: Clinical Research and Therapeutic Innovations)

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Abstract

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus with rising prevalence. Dupilumab (DUPI), a monoclonal antibody that targets the interleukin-4 receptor α, has shown promise as a treatment option. We conducted a systematic review and network meta-analysis of randomized controlled trials searching the PubMed/Medline database, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials (CENTRAL), and the medRxiv preprint server up to 31 July 2024, assessing DUPI’s efficacy and optimal dosing in the treatment of EoE. Finally, three randomized-controlled trials comprising 470 participants, including 102 children under 12 years of age, were included in the qualitative synthesis. Both high-exposure (HE-DUPI, 300 mg weekly) and low-exposure (LE-DUPI, 300 mg biweekly) regimens achieved significant histologic remission relative to placebo (OR = 26.88, 95% CI 11.98–60.29 for LE-DUPI; OR = 29.15, 95% CI 13.68–62.12 for HE-DUPI). Although overall adverse events were comparable between groups, HE-DUPI was associated with a notable increase in serious adverse events. These findings suggest that DUPI is effective in promoting histologic remission in EoE, with LE-DUPI emerging as a preferred option for balancing efficacy and safety. This study highlights the efficacy and safety profiles of different dosing regimens and pediatric groups. Further studies are warranted to explore long-term outcomes and identify patient subgroups that may derive the greatest benefit from DUPI therapy.

Keywords: dupilumab; eosinophilic esophagitis; biological agents; monoclonal antibody

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MDPI and ACS Style

Chu, S.-H.; Chen, J.-J.; Chen, C.-C.; Lei, W.-T.; Lien, C.-H.; Weng, S.-L.; Yeung, C.-Y.; Liu, L.Y.-M.; Tai, Y.-L.; Huang, Y.-N.; et al. Efficacy of Dupilumab in the Treatment of Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Life 2025, 15, 307. https://doi.org/10.3390/life15020307

AMA Style

Chu S-H, Chen J-J, Chen C-C, Lei W-T, Lien C-H, Weng S-L, Yeung C-Y, Liu LY-M, Tai Y-L, Huang Y-N, et al. Efficacy of Dupilumab in the Treatment of Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Life. 2025; 15(2):307. https://doi.org/10.3390/life15020307

Chicago/Turabian Style

Chu, Szu-Hung, Jeng-Jung Chen, Chung-Chu Chen, Wei-Te Lei, Chi-Hone Lien, Shung-Long Weng, Chun-Yan Yeung, Lawrence Yu-Ming Liu, Yu-Lin Tai, Ya-Ning Huang, and et al. 2025. "Efficacy of Dupilumab in the Treatment of Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials" Life 15, no. 2: 307. https://doi.org/10.3390/life15020307

APA Style

Chu, S.-H., Chen, J.-J., Chen, C.-C., Lei, W.-T., Lien, C.-H., Weng, S.-L., Yeung, C.-Y., Liu, L. Y.-M., Tai, Y.-L., Huang, Y.-N., & Lin, C.-Y. (2025). Efficacy of Dupilumab in the Treatment of Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Life, 15(2), 307. https://doi.org/10.3390/life15020307

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Efficacy of Dupilumab in the Treatment of Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

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