DUPILUMAB: A NEW ALLY FOR THE TREATMENT OF EOSINOPHILIC ESOPHAGITIS?

Abstract

INTRODUCTION: Eosinophilic esophagitis is a chronic and immune-mediated disease of the gastrointestinal tract, resulting from the interaction between genetic, environmental and immunological factors of the affected patient. The clinical picture is characterized by esophageal dysfunction, which may present as dysphagia, chest pain, upper abdominal pain or food impaction. Treatment aims to improve clinical symptoms and prevent disease progression and subsequent complications. In this context, immunobiologicals are emerging and promising therapies, with Dupilumab being the first specific treatment approved by the FDA. It is an IgG4 monoclonal antibody, which targets IL-4R alpha and, from this, reduces protein transforylation, transcription, and the T helper 2-regulated response. The objective of this systematic review is to evaluate the efficacy of this drug in the treatment of eosinophilic esophagitis, in comparison with the options already available on the market. METHODS: PubMed searches were performed using the keywords "eosinophilic esophagitis dupilumab" and "dupilumab treatment esophagitis eosinophilic". At first, 60 results were obtained, but after exclusion by title and abstract, and by full text, 14 articles were included. RESULTS: all the articles analyzed showed improvement in patients using Dupilumab, 13 of which showed a reduction in the eosinophil count, 8 showed clinical improvement of symptoms, 8 indicated histological improvement, 7 denoted improvement in the endoscopic pattern, according to the Endoscopic Reference for Eosinophilic Esophagitis, and 4 indicated a reduction in the Dysphagia Symptom Questionnaire (QSD) score. DISCUSSION: Eosinophilic esophagitis is a rare disease, but it has the potential to progress, negatively interfering with the patient's quality of life. Thus, as the current drug therapy is nonspecific, the use of Dupilumab presents itself as an innovative and optimistic solution for the future, because it modifies the understanding of the management of the disease, expands the therapeutic options and improves the prognosis. CONCLUSION: The use of Dupilumab in the treatment of eosinophilic esophagitis has been shown to be effective. However, for treatment to be well established with regard to the doses used, frequency of administration and longitudinal monitoring, further studies are still needed.

DOI:https://doi.org/10.56238/sevened2024.031-054