Dupilumab, a fully human monoclonal antibody, improves esophageal distensibility in patients with eosinophilic esophagitis (EoE), with beneficial effects on endoscopic and histologic outcomes as well, according to results of the phase 4 REMODEL study presented at the American College of Gastroenterology’s 2026 annual meeting.
Least-squares mean (LSM) gain in esophageal distensibility plateau (DP) was about 1.3 mm greater after 24 weeks in patients randomized to dupilumab versus placebo. The change was driven by particularly large gains in the subset with low baseline DP (<17 mm), who saw an LSM increase of 2.21 mm relative to their placebo-treated counterparts.
“This is over the course of the trial with no dilation, just from the medication,” Evan Dellon, MD, director of the Center for Esophageal Diseases and Swallowing at the University of North Carolina at Chapel Hill, said during his presentation.
Overall, the findings, which were published simultaneously online in the American Journal of Gastroenterology, “suggest that dupilumab is effective across the fibrostenotic-to-inflammatory spectrum of EoE,” he concluded.
Without treatment, EoE can lead to epithelial barrier dysfunction and fibrostenotic remodeling, which in turn constricts the esophageal lumen and puts patients at risk for dysphagia, food impaction, and poorer quality of life. Dupilumab reduces inflammation by blocking the interleukin-4 and -13 signaling that may be involved in esophageal remodeling.
Dellon reported the 24-week results from the REMODEL trial, which included 69 adults (mean age 37 years; 33% women) with active, symptomatic EoE who did not respond to prior proton pump inhibitor therapy. More than 60% had received prior corticosteroid therapy and had any comorbid atopic disease, with 44% having undergone prior esophageal dilation. Mean DP diameter, measured with the endoluminal functional lumen imaging probe (EndoFLIP), was about 17 mm at baseline; 43% had a diameter <17 mm, a threshold that identifies individuals with a heightened risk of food impaction.
Dupilumab-treated patients were more likely than those who received placebo to have gains in esophageal DP diameter of least 1 mm (44% vs 13%), 2 mm (28% vs 0), and 3 mm (15% vs 0), with more substantial benefits seen in the group with low baseline DP.
Endoscopic severity assessed using the EoE-Endoscopic Reference Score, including total score and inflammatory and fibrostenotic subscores; histologic severity based on EoE Histologic Scoring System grade and stage scores; and peak esophageal intraepithelial eosinophil counts all improved over the course of the study as well.
Dellon reported, too, that quality of life got better after 24 weeks of treatment.
In terms of safety, at least one treatment-emergent adverse event was seen in 62% of patients in the dupilumab group and 48% of those in the placebo group.
“Dupilumab was generally well tolerated in the patients with EoE, and . . . the most common treatment-emergent adverse events were non-serious, self-limiting, and similar between groups,” Dellon said.
He was asked during a panel discussion after his presentation about how long clinicians should wait after initiating dupilumab to check for response.
“For my own practice, most patients are about 24 weeks, but I individualize that,” he said. “If someone starts [out] really severe and needs more dilation, I may do them earlier at about 12 weeks. The phase 2 study showed efficacy at 12 weeks as well.”
