We read with interest the recent paper by Bredenoord et al,1 in which the authors performed a subgroup analysis of a phase 3 study of dupilumab 300 mg once a week (LIBERTY EoE TREET) showing that dupilumab was effective and well tolerated in patients with eosinophilic oesophagitis (EoE) regardless of prior topical corticosteroids (TCs) use or inadequate response, intolerance and/or contraindication (inadequate/intolerance/contraindication) to TCs. In this regard, it has also been shown that prior treatment with off-label TCs can have an impact on the response to proton pump inhibitors (PPIs) in EoE,2 while evidence on whether prior failure to respond to PPIs or off-label TCs impacts on medical or dietary second-line treatments is conflicting.3 4

The results of Bredenoord et al 1 are positive and reassuring for practitioners but deserve a critical appraisal. In our recent systematic review with network meta-analysis,5 dupilumab 300 mg once a week for 24 …