Joshua Wechsler, MD, on dupilumab's sustained efficacy in pediatric patients with EoE

At the 2025 North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) Annual Meeting in Chicago, new data highlighted continued benefits of dupilumab in children and adolescents with eosinophilic esophagitis (EoE). The abstract, titled “Dupilumab Improves Histologic and Endoscopic Features of Pediatric Onset Eosinophilic Esophagitis (EoE): Pooled Results From the EoE KIDS and LIBERTY EoE TREET Studies,” demonstrated that dupilumab produced significant and sustained histologic and endoscopic improvements across all pediatric age groups.

The pooled phase 3 analysis included patients aged 1 to <18 years treated with weight-tiered or fixed-dose dupilumab in the EoE KIDS and LIBERTY EoE TREET trials. Compared with placebo, dupilumab achieved markedly higher rates of histologic remission—defined as ≤6 eosinophils per high-power field—across all ages, with the youngest cohort (1 – <6 years) showing the highest response rates. These improvements were sustained or further enhanced through week 52, underscoring the therapy’s durable impact on disease control.

Specifically, at the end of the double-blind treatment period, dupilumab resulted in significantly greater proportions of patients achieving ≤6 and <15 eos/hpf vs placebo in all age groups, respectively (all P < 0.0001):

• Ages ≥1–<6 years: 85.7% vs 0.0% and 100.0% vs 0.0%
• Ages ≥6–<12 years: 56.5% vs 3.8% and 73.9% vs 3.8%
• Ages ≥12–<18 years: 51.4% vs 5.7% and 67.6% vs 5.7%

In a discussion with HCPLive at NASPGHAN, Joshua Wechsler, MD, MSCI, Medical Director, Eosinophilic Gastrointestinal Diseases Program; Attending Physician, Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children’s Hospital of Chicago, emphasized that the findings “really speak to the durability of treatment.” He explained, “This really tells us that, over time, the endpoints that we look at for therapy — things like eosinophil count and endoscopic measures — remain improved and potentially may even get better over time.”

“This is really important, because that term maintenance phase, when it comes to treatment of EoE, is so incredibly important,” Wechsler continued. “We don’t really just want to get our patients into remission and then pause therapy and wait for them to get sick again. We really want to keep that inflammation at bay.”

Going forward, Wechsler noted that dose optimization remains an active area of investigation, and hopes future research can explore ideal dosing.

“One of the key questions for dupilumab, in my mind, is what’s ultimately the key dose that’s necessary to achieve remission?” he said. “At least what we know from studies in adolescents is that the symptoms are more impacted with the higher doses.”

As far as early treatment initiation, “There’s certainly a potential that the earlier we treat the disease — even potentially with dupilumab or other therapy — there’s a significant long-term potential to really impact outcomes,” Wechsler said.

Reference:

Zevit N. Wechsler J. Markowitz J, et al. DUPILUMAB IMPROVES HISTOLOGIC AND ENDOSCOPIC FEATURES OF PEDIATRIC ONSET EOSINOPHILIC ESOPHAGITIS (EOE): POOLED RESULTS FROM THE EOE KIDS AND LIBERTY EOE TREET STUDIES. Abstract. Presented at: 2025 NASPGHAN Annual Meeting. November 5-9, 2025. Chicago, Illinois.