P-083 YI Teduglutide Use for Intestinal Failure in Inflammatory Bowel Disease. (March 2016)

• Record Type: Journal Article
• Authors: Micic, Dejan; Wall, Elizabeth; Rubin, David; Semrad, Carol
• Is Part Of: Inflammatory bowel diseases. Volume 22(2016:Mar.)Supplement 1
• Publication Date: 2016-03
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1097/01.MIB.0000480177.66156.2a
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract : Background: Inflammatory bowel disease (IBD) is a common cause for intestinal failure (IF). Up to one third of home parenteral nutrition (PN) patients have an underlying diagnosis of IBD. Home PN is associated with multiple infectious, thrombotic and hepatobiliary complications. Until recently, there were few alternatives to PN. In December 2012, the Food and Drug Administration approved the use of teduglutide, a glucagon-like peptide 2 analogue (GLP-2), for adult patients with short bowel syndrome who are dependent on parenteral support. The recombinant GLP-2 analog results in growth of intestinal villi, a reduction in gastric emptying and reduction in intestinal secretions, which results in increase of fluid and electrolyte absorption. The largest clinical trial with teduglutide demonstrated that 68% of patients who received teduglutide had a >20% reduction in PN support and >1 day independence from PN infusions. Here we describe a single center experience of using teduglutide for the management of IF secondary to IBD. Methods: All patients who were assessed for initiation of teduglutide due to IF at The University of Chicago Medicine (UCM) were eligible to enroll in a Teduglutide Registry. Criteria used at UCM for teduglutide initiation are listed in Table 1. Patients agreeing to enter a pre-defined Teduglutide Registry were included for analysis. Data was retrospectively collected from the medical chart of enrolled patients and included: anthropometric and laboratory data; PN volume, nutrient density and infusion data; and potential side effects from teduglutide. Results: Eight patients from the UCM Teduglutide Registry had a history of IBD (5 Crohn's disease, 2 ulcerative colitis, 1 indeterminate colitis). The initial teduglutide dose was 0.05 mg·kg −1 ·d −1 for all patients. The median use of PN prior to initiation of teduglutide was 3 years (range 1–31). The median duration of teduglutide use was 92 weeks (range 8–124). Seven patients were able to achieve a >20% reduction in PN volume at 20 weeks. Five patients had available data 52 weeks after starting teduglutide. At 52 weeks, 5 had a >20% reduction in PN volume while 4 had a reduction of 1 or more days of PN dependency. Through the end of follow-up, reported complications included stomal hyperplasia and intestinal obstruction in 2 patients, leg pain, headache and development of breast cancer. Conclusions: IBD patients requiring teduglutide for IF demonstrate favorable 20 and 52-week reductions in PN volume and support. Prolonged monitoring is required with respect to the development of complications and continued monitoring of nutritional status.