Less Can Be Enough: Sustained Remission of Pediatric Eosinophilic Esophagitis With Low‐Frequency Dupilumab

ABSTRACT Eosinophilic esophagitis (EoE) is a chronic, immune‐mediated disease requiring long‐term therapy. Dupilumab, an interleukin‐4 and interleukin‐13 receptor antagonist, is approved for EoE at a weekly 300 mg dosing regimen. However, data on reduced‐frequency dosing, especially in pediatric patients, remain limited. This is the case of a 12‐year‐old girl presented with vomiting, food impaction, and dysphagia. Endoscopy revealed longitudinal furrows and whitish exudates (EREFS 4), and histology confirmed EoE with 75 eosinophils/high‐power field (HPF) and high EoEHSS grade and stage scores. Conventional therapies with proton pump inhibitors, topical fluticasone, and an elimination diet achieved only partial improvement. Dupilumab (300 mg every 2 weeks) induced complete clinical, endoscopic (EREFS 0), and histologic remission (EoEHSS grade/stage 0–1, peak < 6 eos/HPF) after 6 months. Given the remission and parental concern about prolonged therapy, the dosing interval was cautiously extended to every 3 weeks as a monitored off‐label trial. Topical steroids and dietary restrictions were discontinued. The patient remained asymptomatic and in complete histologic remission for more than 2 years (as of August 2025: EREFS 0, EoEHSS 0, with a peak eosinophil count of ≤ 6 eos/HPF) without any adverse events. This case illustrates that sustained remission of pediatric EoE may be achievable with individualized, response‐based dupilumab de‐escalation. While promising, this off‐label approach requires confirmation in prospective studies before routine implementation.