Efficacy and Safety of Dupilumab in Eosinophilic Esophagitis: A Systematic Review and Meta-Analysis

Roy Khalaf, Alexandre Ton That, Natacha Tardioet al.  Int Arch Allergy Immunol 2026

Abstract

Introduction: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus driven by type-2 inflammation. Dupilumab, a monoclonal antibody targeting the IL-4Ra subunit shared by the IL-4 and IL-13 receptor complexes , has recently emerged as a targeted biologic therapy for EoE. This systematic review evaluates the evidence for dupilumab in EoE across pediatric and adult populations, focusing on efficacy, safety, and symptom improvement. 

Methods: MEDLINE and Embase were searched from inception to June 30, 2025. Eligible studies included randomized controlled trials, cohort studies, case-control studies, and case reports reporting dupilumab use in confirmed EoE. Study screening and quality assessment were performed in duplicate. . Data on demographics, atopic comorbidities, dosing regimens, histologic outcomes, symptom improvement, and adverse events were extracted and summarized descriptively. 

Forest plot of histological remission rates with dupilumab
across included randomized controlled trials

Results: Nineteen studies (three randomized trials, nine cohorts, seven case reports) comprising 760 patients were included.

Dupilumab was most commonly initiated following inadequate response or intolerance to proton pump inhibitors, swallowed corticosteroids, or dietary therapy. Across RCTs, histologic remission (≤15 eos/hpf) occurred in 60%–84% of dupilumab-treated patients versus <10% of placebo. Cohort studies demonstrated comparable rates (68%–93%), with pediatric cohorts showing particularly robust responses (up to 90% remission). Meta-analysis using a random-effects logit model demonstrated a pooled histologic remission rate of 75.5% (95% CI, 67.4–82.1%) and a symptom improvement rate of 84.1% (95% CI, 77.8–88.9%). 

Conclusions: Dupilumab represents a promising therapeutic option, particularly for patients with inadequate response to PPI therapy, including those unable to maintain dietary restrictions. Future research should focus on predictors of response, durability of remission beyond one year, and comparative effectiveness relative to other therapies.

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