{
  "abstract": "Background:: Eosinophilic esophagitis (EoE) is increasingly treated with swallowed topical corticosteroids (STCs) and, more recently, dupilumab, but these interventions have rarely been compared directly. We synthesized randomized evidence comparing dupilumab, individual STC formulations, a proton pump inhibitor and placebo across histologic and symptomatic outcomes.\n\nMethods:: We performed a systematic review and frequentist random-effects network meta-analysis (NMA), reported according to PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Network Meta-Analyses), of randomized controlled trials in patients aged ≥ 12 years with EoE. PubMed, the Cochrane Central Register of Controlled Trials and Embase were searched from inception to June 2026. Corticosteroid formulations were modeled as separate treatment nodes. Co-primary outcomes were histologic remission at a stringent threshold (≤6 eos/hpf) and change in dysphagia score. Risk of bias was assessed with the Cochrane RoB 2 tool. The protocol was registered on PROSPERO (CRD420261433297).\n\nResults:: Eleven trials (829 participants, 27 treatment arms) were included. Both dupilumab and several STC formulations were more effective than placebo for histologic and symptomatic outcomes. However, most networks were sparse and star-shaped, with zero or near-zero placebo event rates; relative-effect estimates were therefore highly imprecise and depended substantially on continuity corrections. No comparison between 2 active treatments reached statistical significance in any histologic network. Safety networks were underpowered and could not exclude clinically meaningful differences between treatments.\n\nConclusions:: Dupilumab and swallowed topical corticosteroids both demonstrate efficacy versus placebo in EoE. However, no statistically significant differences were observed between any 2 active treatments. Owing to sparse data, heterogeneous histologic thresholds and reliance on indirect comparisons, these findings are hypothesis-generating only, and adequately powered head-to-head trials are needed.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine, St. Luke’s Hospital, Chesterfield, MO",
    "Department of Internal Medicine, Khyber Girls Medical College, Peshawar, Pakistan",
    "Department of Internal Medicine, Qazi Hussain Ahmad Medical Complex, Nowshera, KPK, Pakistan",
    "Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan",
    "Department of Internal Medicine, Nishtar Medical University, Multan, Pakistan",
    "Department of Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan",
    "Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan",
    "Department of Internal Medicine, Gajju Khan Medical College, Swabi, Pakistan",
    "Department of Internal Medicine, Fazaia Medical College, Islamabad, Pakistan",
    "Department of Internal Medicine, Bacha Mardan Medical College, Mardan, Pakistan",
    "Department of Internal Medicine, Khyber Medical College, Peshawar, Pakistan",
    "Department of Internal Medicine, Gomal Medical College, DI-Khan, Pakistan."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Muhammad Arsalan"
    },
    {
      "affs": [
        1
      ],
      "name": "FNU Sawaira"
    },
    {
      "affs": [
        2
      ],
      "name": "Suliman Shah"
    },
    {
      "affs": [
        3
      ],
      "name": "Fatima Bhatti"
    },
    {
      "affs": [
        4
      ],
      "name": "Faizan E. Mustafa"
    },
    {
      "affs": [
        5
      ],
      "name": "Ahmad Shafi Antar"
    },
    {
      "affs": [
        6
      ],
      "name": "Muhammad Shahzaib"
    },
    {
      "affs": [
        7
      ],
      "name": "Abdul Majid"
    },
    {
      "affs": [
        6
      ],
      "name": "Taimoor Hassan"
    },
    {
      "affs": [
        8
      ],
      "name": "Tehreem Zubair"
    },
    {
      "affs": [
        9
      ],
      "name": "Muhammad Yasir"
    },
    {
      "affs": [
        10
      ],
      "name": "Muhammad Junaid"
    },
    {
      "affs": [
        11
      ],
      "name": "Farman Ullah",
      "orcid": "0009-0006-8107-2322"
    },
    {
      "affs": [
        4
      ],
      "name": "Sarim Hassan Shahab"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fdffx698zqqsz.bib",
  "cited_by": 0,
  "doi": "10.1097/md.0000000000051186",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13727196/?tool=EBI",
  "id": "fdffx698zqqsz",
  "issns": [
    "0304-5412",
    "1536-5964",
    "0025-7974"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13727196",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "4500"
    ],
    [
      "heading",
      "Research Article"
    ],
    [
      "heading",
      "Systematic Review and Meta-Analysis"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13727196/pdf/?tool=EBI",
  "pmcid": "PMC13727196",
  "pmid": null,
  "published": "2026-10-30",
  "publisher": "Wolters Kluwer Health",
  "ris": "https://research.draconitic.com/paper/fdffx698zqqsz.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T15:20:51Z",
      "native_id": "PMC:PMC13727196",
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    },
    {
      "first_seen": "2026-11-05T12:23:20Z",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
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  ],
  "title": "Comparative efficacy and safety of dupilumab and swallowed topical corticosteroid formulations in eosinophilic esophagitis : A systematic review and network meta-analysis of randomized controlled trials",
  "title_text": "Comparative efficacy and safety of dupilumab and swallowed topical corticosteroid formulations in eosinophilic esophagitis : A systematic review and network meta-analysis of randomized controlled trials",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T12:23:20Z",
  "url": "https://research.draconitic.com/paper/fdffx698zqqsz",
  "venue": "Medicine",
  "versions": []
}