Chu Szu-Hung, Chen Jeng-Jung, Chen Chung-Chu, Lei Wei-Te, Lien Chi-Hone, Weng Shung-Long, Yeung Chun-Yan, Liu Lawrence Yu-Ming, Tai Yu-Lin, Huang Ya-Ning, Lin Chien-Yu
Department of Pediatrics, Hsinchu Municipal MacKay Children's Hospital, Hsinchu 30070, Taiwan.
Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan.
Life (Basel). 2025 Feb 17;15(2):307. doi: 10.3390/life15020307.
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus with rising prevalence. Dupilumab (DUPI), a monoclonal antibody that targets the interleukin-4 receptor α, has shown promise as a treatment option. We conducted a systematic review and network meta-analysis of randomized controlled trials searching the PubMed/Medline database, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials (CENTRAL), and the medRxiv preprint server up to 31 July 2024, assessing DUPI's efficacy and optimal dosing in the treatment of EoE. Finally, three randomized-controlled trials comprising 470 participants, including 102 children under 12 years of age, were included in the qualitative synthesis. Both high-exposure (HE-DUPI, 300 mg weekly) and low-exposure (LE-DUPI, 300 mg biweekly) regimens achieved significant histologic remission relative to placebo (OR = 26.88, 95% CI 11.98-60.29 for LE-DUPI; OR = 29.15, 95% CI 13.68-62.12 for HE-DUPI). Although overall adverse events were comparable between groups, HE-DUPI was associated with a notable increase in serious adverse events. These findings suggest that DUPI is effective in promoting histologic remission in EoE, with LE-DUPI emerging as a preferred option for balancing efficacy and safety. This study highlights the efficacy and safety profiles of different dosing regimens and pediatric groups. Further studies are warranted to explore long-term outcomes and identify patient subgroups that may derive the greatest benefit from DUPI therapy.
嗜酸性粒细胞性食管炎(EoE)是一种患病率不断上升的慢性免疫介导性食管疾病。度普利尤单抗(DUPI)是一种靶向白细胞介素-4受体α的单克隆抗体,已显示出作为一种治疗选择的前景。我们对截至2024年7月31日在PubMed/Medline数据库、Cochrane系统评价数据库、Cochrane对照试验中央注册库(CENTRAL)和medRxiv预印本服务器中检索到的随机对照试验进行了系统评价和网状荟萃分析,评估DUPI治疗EoE的疗效和最佳剂量。最后,定性综合分析纳入了三项随机对照试验,共470名参与者,其中包括102名12岁以下儿童。与安慰剂相比,高剂量暴露(HE-DUPI,每周300 mg)和低剂量暴露(LE-DUPI,每两周300 mg)方案均实现了显著的组织学缓解(LE-DUPI的OR = 26.88,95%CI为11.98 - 60.29;HE-DUPI的OR = 29.15,95%CI为13.68 - 62.12)。尽管各组之间总体不良事件相当,但HE-DUPI与严重不良事件显著增加相关。这些发现表明,DUPI在促进EoE的组织学缓解方面是有效的,LE-DUPI成为平衡疗效和安全性的首选方案。本研究突出了不同给药方案和儿科组的疗效和安全性概况。有必要进行进一步研究以探索长期结果,并确定可能从DUPI治疗中获益最大的患者亚组。