Treatment patterns of eosinophilic esophagitis in the biologic era—a real-world analysis

Eosinophilic esophagitis is a chronic immune-mediated disease requiring a long-term maintenance treatment. The data on therapy patterns and treatment durability in the biologic era are scarce in a real-world setting. The aim of this project was to provide information on the treatment courses in a real-world setting over past 10 years. Data on demographics, concomitant atopic diseases and treatments were collected retrospectively at seven Austrian centres. The eligible subjects had to start their first therapy between January 2014 and February 2025. In total, 336 patients (30.1% female) were analyzed of whom 34.5% remained on the first line treatment. In a mean time of 7.6 months, a second line treatment was started. The most common first line treatment was swallowed topical corticosteroids (STCs) (54.2%), followed by proton pump inhibitors (22.3%) and food elimination diet (6.0%). In contrast to only a minority who continued on PPI therapy after starting it (21.3%), the majority of patients had ongoing STC treatment (51%). Forty-one (12.2%) patients received a treatment with dupilumab of whom only one as first line treatment (because of multiple type 2 inflammatory diseases) and the majority as second line treatment (57.5%). The reasons for dupilumab were non-response to STC (59%), followed by side effects (24%). 97.6% (40/41) of them remained on dupilumab until the last follow-up. Although most patients receive STC at the beginning, the majority need multiple treatment lines. Dupilumab is used in a tenth of patients due to refractoriness, side-effects or treatment of other type 2 inflammatory diseases.