Experience with teduglutide treatment for short bowel syndrome in clinical practice

Sophie Pevny; Sebastian Maasberg; Anja Rieger; Mirjam Karber; Elisabeth Blüthner; Barbora Knappe-Drzikova; Dana Thurmann; Janine Büttner; Karsten-Henrich Weylandt; Bertram Wiedenmann; Verena Alexandra Müller; Hendrik Bläker; Andreas Pascher; Ulrich-Frank Pape

doi:10.1016/j.clnu.2018.07.030

Experience with teduglutide treatment for short bowel syndrome in clinical practice

Clin Nutr. 2019 Aug;38(4):1745-1755. doi: 10.1016/j.clnu.2018.07.030. Epub 2018 Aug 2.

Authors

Affiliations

¹ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany. Electronic address: Sophie.Pevny@charite.de.
² Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany. Electronic address: Sebastian.Maasberg@charite.de.
³ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Pathology, Berlin, Germany. Electronic address: Anja.Rieger@charite.de.
⁴ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany. Electronic address: Mirjam.Karber@charite.de.
⁵ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum, Berlin, Germany. Electronic address: Elisabeth.Bluethner@charite.de.
⁶ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany. Electronic address: Barbora.Knappe-Drzikova@charite.de.
⁷ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany. Electronic address: Dana.Thurmann@charite.de.
⁸ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany. Electronic address: Janine.Buettner@charite.de.
⁹ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany; Ruppiner Kliniken, Brandenburg Medical School, Medical Department, Division of Gastroenterology, Oncology, Hematology, Rheumatology and Diabetes, Neuruppin, Germany. Electronic address: Karsten.Weylandt@charite.de.
¹⁰ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany. Electronic address: Bertram.Wiedenmann@charite.de.
¹¹ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum, Berlin, Germany. Electronic address: Verena.Mueller@charite.de.
¹² Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Pathology, Berlin, Germany. Electronic address: Hendrik.Blaeker@charite.de.
¹³ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum, Berlin, Germany. Electronic address: Andreas.Pascher@ukmuenster.de.
¹⁴ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany. Electronic address: Ulrich-Frank.Pape@charite.de.

PMID: 30145039
DOI: 10.1016/j.clnu.2018.07.030

Abstract

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.

Keywords: Glucagon-like peptide 2; Intestinal adaptation; Intestinal failure; Nutritional status; Parenteral nutrition; Teduglutide.

MeSH terms

Adult
Aged
Aged, 80 and over
Chronic Disease
Female
Gastrointestinal Agents / administration & dosage
Gastrointestinal Agents / adverse effects
Gastrointestinal Agents / therapeutic use*
Glucagon-Like Peptide 2
Humans
Intestines / physiopathology
Male
Middle Aged
Nutritional Status
Parenteral Nutrition
Peptides / administration & dosage
Peptides / adverse effects
Peptides / therapeutic use*
Retrospective Studies
Short Bowel Syndrome* / epidemiology
Short Bowel Syndrome* / physiopathology
Short Bowel Syndrome* / therapy
Young Adult

Substances

Gastrointestinal Agents
Glucagon-Like Peptide 2
Peptides
teduglutide