Monoclonal Antibodies' Efficacy on Dysphagia Symptoms and Histological Remission in Patients With Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

American Journal of Gastroenterology

Abstract

Introduction: Eosinophilic esophagitis (EoE) is an increasingly recognized cause of dysphagia unresponsive to anti-acid measures, leading to impaired quality of life, with a prevalence ranging from 0.5-1 case per 1,000. The pathophysiology of EoE is complex, driven primarily by eosinophils, T-cells, Interleukin (IL)-4, IL-5, and IL-13. This network meta-analysis aims to compare the efficacy of monoclonal antibodies to placebo and to each other using indirect meta-analysis to evaluate improvements in dysphagia symptoms at weeks 12 and 24 and the achievement of histologic remission within 24 weeks. Methods: A comprehensive search of PubMed, Cochrane, Scopus, Web of Science, and ClinicalTrials.gov was conducted up to October 2024. Only randomized controlled trials (RCTs) were included, focusing on 4 different monoclonal antibodies: dupilumab, benralizumab, mepolizumab, and RPC4046. Outcomes were dysphagia symptoms and histological remission. Dysphagia symptoms were assessed using different scales. Therefore, we used standardized differences in means to compare their results. Histological remission was defined as a peak esophageal intraepithelial eosinophil count of ≤6 per high-power field. Odds ratios (OR) with 95% confidence intervals (CI) were used to determine histological remission. Results: We included 5 studies, with 1 study reporting 2 independent trials. Consequently, 6 RCTs comprising 631 patients were included in the final analysis. All RCTs compared monoclonal antibodies with a placebo, with 145 patients treated with dupilumab, 103 received benralizumab, 32 received mepolizumab, 34 received RPC4046, and 317 individuals assigned to the placebo group. At week 12, dupilumab had the highest decrease in dysphagia symptoms compared to placebo (SMD: -3.74; 95% CI -4.65 to -2.82). In addition, dupilumab showed statistically significant improvement of dysphagia symptoms compared to other agents. At 24 weeks, dupilumab showed a significant reduction in dysphagia symptoms compared to placebo (SMD: -5.03; 95% CI -5.61 to -4.44), while benralizumab had a higher rate of dysphagia symptoms compared to placebo (standardized mean difference: 1.52; 95% CI 1.20 to 1.84). However, benralizumab achieved the highest statistically significant increase in histological remission compared to placebo (OR 98.90; 95% CI 37.79 to 258.80). Conclusion: Dupilumab showed the greatest improvement in dysphagia symptoms at both 12 and 24 weeks, while benralizumab was most effective in achieving histological remission. These results highlight the differing strengths of monoclonal antibodies in treating EoE.

Volume

120

Issue

10S2

First Page

S212

Comments

American College of Gastroenterology Annual Meeting, October 24-29, 2025, Phoenix, AZ

Last Page

S213

DOI

10.14309/01.ajg.0001131408.20895.b8

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