Dupilumab in Gastrointestinal Allergies beyond the Esophagus

Eosinophilic gastrointestinal disorders (EGIDs) are a group of chronic inflammatory conditions characterized by eosinophil infiltration into the gastrointestinal (GI) tract, which includes eosinophilic esophagitis (EoE), eosinophilic gastritis (EoG), eosinophilic duodenitis (EoD), eosinophilic colitis, and other forms of non-EoE EGIDs. While EoE has been well-studied, other forms of eosinophilic gastrointestinal involvement remain rare and lack diagnostic criteria, and standardized treatment options. The recent approval of Dupilumab, an IL-4 receptor antagonist, for the treatment of EoE, has spurred interest in its potential efficacy for other eosinophilic conditions with similar histological findings. This systematic review explores the emerging role of Dupilumab in the treatment of non-EoE EGIDs, including eosinophilic gastritis, duodenitis, and colitis, by analyzing available case reports, case series, and clinical trials published from 2015 onward. A total of four studies met the inclusion criteria, involving 17 patients (13 adults and 4 children) who were treated with Dupilumab. The results from these studies suggest that Dupilumab treatment led to significant clinical improvement, including a reduction in abdominal pain, dysphagia, and iron deficiency anemia, with corresponding endoscopic and histologic remission as evidenced by a decrease in tissue eosinophilia. Additionally, patients showed improved tolerance to trigger foods and reduced reliance on steroids. The duration of treatment varied, with most patients receiving 300 mg of Dupilumab either weekly or biweekly for an average of 6 - 12 months. Despite promising results, the optimal dosing regimen, long-term efficacy, and safety profile of Dupilumab in non-EoE EGIDs require further investigation through larger clinical trials. The review also highlights the potential for Dupilumab to serve as an alternative to steroids, particularly for patients with steroid-resistant or dependent forms of EGID. In conclusion, Dupilumab offers a promising new therapeutic option for patients with eosinophilic gastrointestinal disorders, but further studies are essential to better define its role in the treatment of these rare and complex diseases.