Citrulline correlations in short bowel syndrome–intestinal failure by patient stratification: Analysis of 24 weeks of teduglutide treatment from a randomized controlled study. Issue 8 (August 2020)

• Record Type: Journal Article
• Authors: Jeppesen, Palle Bekker; Gabe, Simon M.; Seidner, Douglas L.; Lee, Hak-Myung; Olivier, Clément
• Is Part Of: Clinical nutrition. Volume 39:Issue 8(2020)
• Page Start: 2479
• Page End: 2486
• Publication Date: 2020-08
• Subjects: Short bowel syndrome -- Intestinal failure -- Parenteral support -- Citrulline -- Teduglutide; GLP glucagon-like peptide -- IBD inflammatory bowel disease -- IF intestinal failure -- PS parenteral support (parenteral nutrition and/or intravenous fluids) -- SBS short bowel syndrome -- Vasc vascular disease; 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.2019.11.001
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: Disease-associated factors influence parenteral support (PS) reduction in response to teduglutide in patients with intestinal failure associated-short bowel syndrome (SBS–IF). We sought to determine correlative relationships between plasma citrulline levels, small bowel length, and PS volume. Methods: A post hoc analysis of plasma citrulline levels from patients in the STEPS 24-week study of teduglutide in patients with SBS−IF. Plasma citrulline was assessed in all patients; patients were stratified 3 times into subgroups based on bowel anatomy, cause of SBS–IF, and baseline PS volumes. Correlation analyses used simple linear regression models. Statistical comparisons between study groups were conducted using 2-sided t tests for 2 independent mean differences. Results: Baseline plasma citrulline correlated with remnant small bowel length (r = 0.355, P = 0.002), but not with baseline PS volume (r = −0.167, P = 0.14), in the overall population. There was a robust correlation between the baseline and Week 24 citrulline (r = 0.705, P < 0.0001), and an inverse correlation between change from baseline in citrulline and PS volume from baseline to Week 24 (r = −0.359, P = 0.001). In all subgroups, patients treated with teduglutide showed numerically greater increases in plasma citrulline at Week 24 compared with placebo. Conclusion: Baseline plasma citrulline showed significant correlations with small bowel length in patients with ≥50% colon remaining/no stoma/colon-in-continuity, and patients with SBS–IF causes other than IBD/vascular disease. Citrulline levels may correlate with PS changes in response to teduglutide and more research may reveal a relationship between citrulline levels within the heterogeneous population of patients with SBS−IF. ClinicalTrials.gov NCT00798967, ClinicalTrialsRegister.eu 2008-006193-15. Highlights: Baseline plasma citrulline levels correlated with small bowel length. After teduglutide, citrulline and PS change from baseline inversely correlated. Citrulline correlations differed with colon length, disease etiology, and PS volume. Disease characteristics of short bowel syndrome influence response to teduglutide.