{
  "abstract": "Eosinophilic Oesophagitis (EOE) has several recognised conventional treatments. More recently dupilumab (anti IL-4 and IL-13) has been shown to an effective treatment for EoE for children and adults. There is a paucity of data on the efficacy of dupilumab in the treatment of refractory EoE or with associated non-EoE EGID. In this study we aimed to identify indication and efficacy of dupilumab in multi-treatment refractory EoE in children.We conducted a retrospective review of patients with eosinophilic oesophagitis (EoE) refractory to conventional therapies who received dupilumab for a minimum of three months at our specialized centre. Clinical (PEESS vers. 2) and histological responses were evaluated at 3 and 6 months following treatment initiation.Four male patients (mean age 13.5 years) were included; three had isolated eosinophilic oesophagitis (EoE), and one had concomitant eosinophilic colitis. Abdominal pain was the predominant symptom (100%), followed by dysphagia, vomiting, and regurgitation (75%), and food impaction (50%). The primary indication for initiating dupilumab was refractory disease despite multiple conventional treatments, including corticosteroids. Two patients (50%) developed adrenal insufficiency secondary to prolonged corticosteroid use. None of the patients achieved clinical or histological remission prior to starting dupilumab. Following dupilumab therapy, two patients (50%) demonstrated both clinical improvement and histological remission at 3 and 6 months respectively. One patient (25%) showed partial clinical response without histological remission within six months of treatment, leading to cessation of steroids and initiation of an elemental diet.Dupilumab is licensed by not remunerated in the UK for children over the age of 1. Due to the requirement for local funding, its use is restricted. Approval has been gained at our site for those who have displayed refractory EoE or who have significant side-effects to treatment. This small study shows that dupilumab can be an effective treatment for this cohort and should be considered by funding bodies for use more widely in the UK.Abstract OC63 Table 1Dupilumab outcomes in children with refractory EoEPatientAgeSexDiagnosisDietPPISteroidsRefractory to steroids diseaseAdrenal suppressionResponse at 3 months of DupilumabResponse at 6 months of DupilumabA13yMEoE11111awaiting assessmentawaiting assessmentB16yMEoE11111remissionremissionC16yMEoE and EGID11110remissionremissionD9yMEoE11110partialActive disease0:No, 1:Yes",
  "authors": [
    {
      "affiliations": [
        "Great Ormond Street Hospital for Children"
      ],
      "name": "Maria Kleitsioti"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital for Children"
      ],
      "name": "Lucy Jackman"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital for Children"
      ],
      "name": "Karen Aris"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital for Children"
      ],
      "name": "Leanne Goh"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital for Children"
      ],
      "name": "Edward Gaynor"
    }
  ],
  "title": "OC63 Dupilumab in highly refractory eosinophilic esophagitis in children",
  "uid": "8470acb8-2142-5080-be46-a94372515305"
}