Evan S. Dellon, MD: Limitations of Phase 3 Trial Data on Dupilumab

This interview segment with HCPLive featured Evan S. Dellon, MD, MPH, during which he describes treatment of eosinophilic esophagitis (EoE) and some limitations of his team’s recent study.

Dellon is known for his work as both professor of medicine and adjunct professor of epidemiology at University of North Carolina School of Medicine’s Center for Esophageal Diseases and Swallowing.

“So when we're thinking about treating EoE, one obstacle is that it's hard to know which treatment is best for a specific patient upfront,” he explained. “And so right now, we recommend that providers use what we call a ‘shared decision making framework,’ which is to discuss all of the treatment options for a patient and come to a decision on which one to use based on their own individual preferences and also the characteristics of their disease.”

Dellon’s presentation on EoE and dupilumab had been given at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2023 Annual Meeting in San Antonio, TX. The sub-analysis in the presentation was on phase 3 trial examining EoE patients titled LIBERTY-EoE-TREET.

“Dupilumab is approved for all EoE patients,” he said. “But the most experience with it is in the more moderate-to-severe patients. And for example, in the approval study, every single person who was enrolled didn't respond to proton pump inhibitors and about half didn't respond to topical steroids.”

He added that early on in treatment, many EoE patients may be given proton pump inhibitors or topical steroids prior to further measures being taken.

Dellon also described some of the limitations of the LIBERTY-EoE-TREET study.

“I think a couple of limitations that I would point out are, number one, none of these tests are available in a commercial lab right now,” he said. “So it's not like someone could go out and check these things.”

He added that another limitation is that a deep dive is needed on the results to see how the “changes that were there are decreasing with the active therapy, how those actually correlate with our other metrics of treatment response.”

The last challenge he described was that it needs to be determined whether the biomarkers measured are specific to EoE.

“In other data presented at the meeting here from that dupilumab study, the majority 80% plus of these patients had other allergic diseases,” he said. “And dupilumab can treat those other allergic diseases too. So we don't know if these markers are going down only because of EoE, or if they're going down because of the other allergic diseases improving or if that actually matters or not.”

For more about Dellon’s presentation featured at AAAAI, view the full interview above.