Use of Teduglutide in Children With Intestinal Failure: A Systematic Review

Francesca Gigola; Maria Chiara Cianci; Roberto Cirocchi; Maria Chiara Ranucci; Marco Del Riccio; Riccardo Coletta; Antonino Morabito

doi:10.3389/fnut.2022.866518

Use of Teduglutide in Children With Intestinal Failure: A Systematic Review

Front Nutr. 2022 Jun 14:9:866518. doi: 10.3389/fnut.2022.866518. eCollection 2022.

Authors

Francesca Gigola¹, Maria Chiara Cianci¹, Roberto Cirocchi², Maria Chiara Ranucci³, Marco Del Riccio⁴, Riccardo Coletta^{1

5}, Antonino Morabito^{1

6}

Affiliations

¹ Department of Pediatric Surgery, Meyer Children's Hospital Academic Centre, Florence, Italy.
² Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
³ Department of Digestive and Emergency Surgery, Santa Maria di Terni Hospital, University of Perugia, Perugia, Italy.
⁴ Postgraduate School of Hygiene and Preventive Medicine, Florence, Italy.
⁵ School of Health and Society, University of Salford, Salford, United Kingdom.
⁶ Meyer Children's Hospital, Department of Neurofarba, University of Florence, Florence, Italy.

Abstract

Background and objectives: Short-bowel syndrome (SBS) results from the loss of a significant portion of the small intestine leading to a state of malabsorption. After an intestinal loss, there is a process of adaptation involving the Glucagon-Like Peptide-2 (GLP-2), an enteroendocrine peptide also involved in nutrient absorption. Teduglutide is a recombinant analog of GLP-2 approved in 2016 to treat selected SBS pediatric patients who are dependent on parenteral support. The present systematic review aims to evaluate the efficacy of Teduglutide in pediatric patients with SBS in reducing the need for parenteral nutrition (PN).

Materials and methods: We performed a literature search on MEDLINE and Embase to include articles up to November 2021. We included articles that involved using Teduglutide in the SBS pediatric population to define its efficacy in reducing the need for PN. The key words used were GLP-2, teduglutide, child.

Results: Fourteen studies completely fulfilled the inclusion criteria. Two hundred 23 patients were treated with Teduglutide, and the median duration of treatment was 45 weeks (IQR: 36-52.5 weeks). One-hundred and fifty-two patients were treated with 0.05 mg/Kg/d of subcutaneous Teduglutide, 38 received 0.025 mg/Kg/d and 8 received either 0.125 mg/Kg/d or 0.20 mg/Kg/d. A total of 36 patients achieved enteral autonomy (EA) after a median of 24 weeks of treatment (IQR: 24-48 weeks) and 149 patients showed a reduction in PN needs in terms of volume, calories, or hours per day. Eleven studies reported complications: gastrointestinal were the most common, with 89 cases reported in treated patients and 11 in non-treated patients.

Conclusion: Teduglutide appears safe and effective in reducing PN requirements and improving EA in the pediatric population. However, more studies are needed to understand its efficacy in the long term and after discontinuation and possible complications.

Systematic review registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42022301593].

Keywords: glucagon-like peptide 2; intestinal adaptation; malabsorption; parenteral nutrition; rare disease; short bowel syndrome.

Publication types

Systematic Review