Long-term results of teduglutide treatment for chronic intestinal failure – Insights from a national, multi-centric patient home-care service program. (October 2022)

• Record Type: Journal Article
• Authors: Greif, Sophie; Maasberg, Sebastian; Wehkamp, Jan; Fusco, Stefano; Zopf, Yurdagül; Herrmann, Hans Joachim; Lamprecht, Georg; Jacob, Torid; Schiefke, Ingolf; von Websky, Martin W.; Büttner, Janine; Blüthner, Elisabeth; Tacke, Frank; Pape, Ulrich-Frank
• Is Part Of: Clinical nutrition ESPEN. Volume 51(2022)
• Page Start: 222
• Page End: 230
• Publication Date: 2022-10
• Subjects: Intestinal failure -- Teduglutide -- Home parenteral support -- Quality of life -- Sleep disturbances -- Infusion time; GLP-2 Glucagon-like peptide-2 -- SBS Short bowel syndrome -- cIF chronic intestinal failure -- SBS-cIF Short bowel syndrome associated intestinal failure -- PS Parenteral support -- PN Parenteral nutrition -- IVF Intravenous fluid (fluid and electrolytes alone) -- QoL Quality of life -- BMI Body mass index; Nutritionally induced diseases -- Periodicals; Metabolism -- Disorders -- Periodicals; 616.39005
• DOI: 10.1016/j.clnesp.2022.08.027
• Languages: English
• ISSNs: 2405-4577

Abstract

Summary: Background & aims: Teduglutide is a Glucagon-like peptide-2 (GLP-2) agonist indicated for the treatment of patients with parenteral support (PS) dependent short bowel syndrome (SBS) with chronic intestinal failure (cIF). Its application is accompanied by a structured nation-wide home-care service program in Germany. We investigated care characteristics and outcome parameters in a clinical real-world observational setting. Methods: Data generated within a therapy-accompanying home-care service program for adult SBS-cIF patients were analyzed retrospectively for patients treated up to 1 year (data cut: April 2020). Results: In total, 52 teduglutide-treated patients were included by 6 German cIF centers. At teduglutide administration start, 49/52 patients were on PS, 3 of them without macronutrients. The majority of patients received individualized parenteral nutrition (PN) (n = 32/46), while 13/46 were on commercial premixed bags. PS application was done by patients themselves (37%), home-care nurses (19%), relatives (8%) or by a combination of those (16%). In patients with PS dependency at baseline and available follow-up data (n = 40–44), teduglutide treatment resulted in significantly reduced PN days, caloric needs, infusion time, and infusion volume after 6 and 12 months. After 1 year, reduction of infusion time was positively correlated with a reduction of PN calories and volume; 30 patients (68%) were responders (PS-volume reduction ≥20%), and 6 patients (14%) were completely weaned off PS. Sleep disturbances per night were significantly reduced after 3 months of treatment and stool characteristics improved in consistency and significantly in frequency, while meal frequency remained stable. Conclusions: Teduglutide treatment associated reduction in PS volume and calories was accompanied by reduced infusion days, infusion times, sleep disturbances, stable oral intake surrogates, and improved stool characteristics, all of these potential parameters for improving quality of life. Furthermore, analyzed care characteristics reflect SBS-cIF treatment as a complex, resource-intensive and demanding task for both, healthcare system and patients.