Real-World Infectious Outcomes with Dupilumab Compared with Proton Pump Inhibitors and Topical Steroid Therapy in Eosinophilic Esophagitis: A Multi-Cohort Propensity-Matched Analysis

Presenter: Kaul R.

This retrospective matched cohort study evaluated the infectious safety of dupilumab in adults with eosinophilic esophagitis (EoE) using the TriNetX Research USA network. Three comparisons were performed: dupilumab versus proton pump inhibitors (PPIs), dupilumab versus topical steroids, and dupilumab versus combined PPI/topical steroid therapy. After matching, cohorts included 3,053, 2,143, and 3,973 patient pairs, respectively. Across the PPI-only and topical steroid-only comparisons, dupilumab showed similar rates of shingles, cellulitis, urinary tract infection, pneumonia, influenza, and COVID-19 compared with comparator therapies.

In the combined PPI/steroid cohort, dupilumab was associated with lower rates of COVID-19, pneumonia, and influenza. Kaplan–Meier analysis showed lower hazards for COVID-19 (HR 0.85; p=0.013) and pneumonia (HR 0.71; p=0.025) with dupilumab. No significant differences were observed for shingles, cellulitis, or urinary tract infection across groups.

Overall, dupilumab was not associated with increased infection risk in real-world EoE management.

Treatment Patterns in Patients with Eosinophilic Esophagitis (EOE) in the USA Treated with Budesonide Oral Suspension, Off-Label Corticosteroids and Dupilumab

Presenter: Sauer B.

This retrospective real-world study evaluated treatment patterns among patients with eosinophilic esophagitis (EoE) receiving budesonide oral suspension (BOS), off-label corticosteroids, or dupilumab in the USA. Using claims data from 2023 to 2025, 12,004 BOS-treated patients were identified from open claims. Most patients were aged 18–44 years (52.2%), male (58.8%), and commercially insured (74.7%). In the closed claims analysis, 1,713 patients received BOS, 16,092 received off-label corticosteroids, and 9,207 received dupilumab. Gastroenterologists were the most common prescribers across all treatment groups. Primary care physicians accounted for 24.5% of off-label corticosteroid prescribers, while allergists/immunologists accounted for 17.7% of dupilumab prescribers.

Before treatment initiation, patients receiving BOS were less likely to have atopic comorbidities compared with those receiving off-label corticosteroids or dupilumab. However, BOS-treated patients were more likely to have dysphagia symptoms and food impaction before treatment initiation. Among patients new to index therapy, BOS recipients were more likely to have received prior EoE treatment within the previous 12 months compared with patients treated with off-label corticosteroids or dupilumab.

Overall, BOS was most commonly prescribed by gastroenterologists and was more frequently used in patients with dysphagia, food obstruction, and prior EoE treatment exposure.

Clinical Impact of High-Dose Esomeprazole-Amoxicillin Dual Therapy as Rescue Treatment for Helicobacter Pylori Infection: A Meta-Analysis of Randomized Controlled Trials

Presenter: Alkasabrah O.

This systematic review and meta-analysis evaluated high-dose esomeprazole-amoxicillin dual therapy (HDDT) as rescue treatment for persistent Helicobacter pylori (H. pylori) infection after prior eradication failure. Four randomized controlled trials involving 1,230 patients were included. HDDT was compared with standard rescue regimens, including bismuth-containing quadruple therapy. HDDT showed similar H. pylori eradication rates compared with standard rescue therapies (RR 0.98; 95% CI 0.89–1.08; p=0.64). Treatment compliance was also comparable between groups (RR 1.04; 95% CI 0.97–1.12; p=0.25).

However, HDDT was associated with significantly fewer adverse events overall (RR 0.28; 95% CI 0.18–0.44; p<0.0001). Gastrointestinal symptoms such as nausea, bloating, and abdominal pain, as well as systemic symptoms including headache, fatigue, and dysgeusia, occurred less frequently with HDDT. No significant differences were observed in serious adverse events or in rates of diarrhoea, dizziness, constipation, decreased appetite, or skin rash.

Overall, HDDT demonstrated comparable efficacy and compliance with improved tolerability compared with standard rescue regimens for H. pylori infection.

Tegoprazan is as Effective as Esomeprazole for Helicobacter Pylori Eradication. Non-Inferiority Trial in Latin Patients

Presenter: Velasco Santiago Y.

This randomized non-inferiority trial evaluated tegoprazan (Tego) versus esomeprazole (Eso) as part of triple therapy for Helicobacter pylori (H. pylori) eradication in Latin American patients. A total of 154 treatment-naive adults with H. pylori infection were randomized to receive either Tego 50 mg or Eso 40 mg, both combined with amoxicillin and clarithromycin for 14 days. H. pylori eradication rates were similar between the Tego and Eso groups (87.01% vs 90.91%; p=0.44). Adverse event rates were also comparable (9.09% vs 12.99%; p=0.44), with all events reported as mild and no treatment discontinuations required.

The most common adverse events were diarrhoea and headache with Tego, and diarrhoea and abdominal pain with Eso. Dyspeptic symptoms significantly improved after treatment in both groups (p<0.001), with no significant differences between treatments. Quality of life improved in most assessed domains following eradication therapy, while laboratory parameters remained within normal ranges.

Overall, tegoprazan demonstrated non-inferior efficacy and a favorable safety profile compared with esomeprazole for H. pylori eradication in a Latin American population.

Concomitant Omeprazole/Esomeprazole and Clopidogrel in Coronary Artery Disease: A Retrospective Propensity-Matched Cohort Study

Presenter: Abdellatief A.

This retrospective cohort study evaluated whether concomitant use of omeprazole or esomeprazole affects cardiovascular outcomes in patients with coronary artery disease (CAD) receiving clopidogrel. Using the TriNetX database, adults with CAD receiving clopidogrel were divided into two matched cohorts: patients receiving clopidogrel with omeprazole/esomeprazole and those receiving clopidogrel without these proton pump inhibitors (PPIs). After propensity matching, each cohort included 615,720 patients. At 6 months, all-cause mortality was slightly higher in the PPI group compared with the non-PPI group (5.9% vs 5.6%; risk ratio [RR]: 1.045; 95% CI: 1.031–1.061). However, acute coronary syndrome (ACS) events were lower in the PPI group (15.7% vs 17.1%; RR: 0.921).

Non-ST elevation myocardial infarction (NSTEMI) events were also lower with PPI use (8.71% vs 10.4%; RR: 0.841; 95% CI: 0.831–0.850). In contrast, ST elevation myocardial infarction (STEMI) and unstable angina rates were slightly higher in the PPI group.

Overall, the study found no clinically meaningful evidence that omeprazole or esomeprazole worsened clopidogrel-related cardiovascular outcomes.

Real-World Efficacy and Patient Satisfaction with Zastaprazan in Erosive Reflux Disease: A Large-Scale Prospective Observational Study

Presenter: Kim Y.

This multicentre prospective observational study evaluated the real-world effectiveness and safety of Zastaprazan citrate in patients with erosive reflux disease (ERD). A total of 5,499 patients received Zastaprazan 20 mg once daily for 4 weeks in routine clinical practice. Symptom improvement was assessed using the Reflux Disease Questionnaire (RDQ). The mean RDQ gastroesophageal reflux disease (GERD) symptom score significantly improved from 2.07 at baseline to 0.44 at week 4 (mean change: −1.63; p<0.0001). Significant improvements were observed across all individual symptom domains. Symptom improvement was consistent in treatment-naïve patients as well as in patients previously treated with histamine-2 receptor antagonists, proton pump inhibitors, or other potassium-competitive acid blockers (P-CABs). Patients who switched to Zastaprazan because of inadequate response to previous therapy also demonstrated significant symptom reduction.

More than 90% of patients reported treatment satisfaction, and medication compliance was high at 93%. Only 2.25% required additional GERD medications during treatment. Adverse drug reactions were reported in only 0.05% of patients, all of which were mild, with no serious adverse events observed.

Overall, Zastaprazan demonstrated meaningful symptom improvement, high patient satisfaction, and a favorable safety profile in real-world ERD management.

DDW 2026, May 2-5, Chicago, IL