Experience with teduglutide treatment for short bowel syndrome in clinical practice. Issue 4 (August 2019)

• Record Type: Journal Article
• Authors: Pevny, Sophie; Maasberg, Sebastian; Rieger, Anja; Karber, Mirjam; Blüthner, Elisabeth; Knappe-Drzikova, Barbora; Thurmann, Dana; Büttner, Janine; Weylandt, Karsten-Henrich; Wiedenmann, Bertram; Müller, Verena Alexandra; Bläker, Hendrik; Pascher, Andreas; Pape, Ulrich-Frank
• Is Part Of: Clinical nutrition. Volume 38:Issue 4(2019)
• Page Start: 1745
• Page End: 1755
• Publication Date: 2019-08
• Subjects: Intestinal failure -- Intestinal adaptation -- Glucagon-like peptide 2 -- Teduglutide -- Parenteral nutrition -- Nutritional status; GLP-2 Glucagon-like peptide-2 -- SBS Short bowel syndrome -- IF Intestinal failure -- SBS-IF Short bowel syndrome associated intestinal failure -- PS Parenteral support -- PN Parenteral nutrition -- IVF Intravenous fluid (fluid and electrolytes alone) -- BIA Bioelectrical impedance analysis -- BW Body weight -- IFALD Intestinal failure associated liver disease -- CRBSI Catheter-related bloodstream infections -- QoL Quality of life -- BMI Body mass index; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2018.07.030
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: Teduglutide, a glucagon-like peptide 2 (GLP-2) analog, is an approved medication specific for short bowel syndrome patients with chronic intestinal failure (SBS-IF). Due to its intestinotrophic properties, it improves intestinal absorption of fluids and nutrients, which was shown to reduce the need for parenteral support in clinical trials. The present report aims to describe the experience of teduglutide's effects in routine medical care with focus on clinical and nutritional effects. Methods: Data of adult SBS-IF patients, treated with teduglutide between Sept. 2014 and May 2017 within a structured multidisciplinary program to enhance intestinal rehabilitation, were analyzed retrospectively from a single university medical center. Results: In total, 27 patients were treated with teduglutide. Parenteral nutrition independency was achieved in 4/19 (21%) patients analyzed, with two remaining on intravenous fluids. A clinically significant reduction of parenteral volume was observed in 15/19 patients (79%) with onset between 1 and 45 weeks. Significant parenteral support reductions were observed, ranging from about −20% in patients treated for 3 months to about −45% in patients treated for 2 years. This was accompanied by an increase in parenteral nutrition-free days. We also report on a clinically relevant and significant effect of teduglutide-mediated improvement of stool frequency and consistency. Furthermore, nutritional status subgroup analysis revealed long-term stability in body weight, albumin levels and body composition albeit parenteral support reduction. Structural effects of teduglutide treatment were observed on small intestinal mucosa with significantly increased villus height, crypt depth and plasma citrulline levels. Conclusions: Teduglutide can be applied to anatomically and clinically heterogeneous SBS-IF patients and results in an adaptive response with variable time and effect range in routine medical care. Teduglutide-induced functional and structural changes bring on a gradual reduction of parenteral support at no cost to body composition and suggest an improved intestinal function with compensatory effect on nutritional status.