Mount Sinai Medical Center, New York, NY, USA.
The Concord Medical Group, New York, NY, USA.
JPEN J Parenter Enteral Nutr. 2018 Jan;42(1):225-230. doi: 10.1002/jpen.1011. Epub 2017 Dec 13.
Teduglutide is a glucagon-like peptide 2 (GLP-2) analog that has been approved for the treatment of adult short bowel syndrome (SBS)-associated intestinal failure (IF; SBS-IF). Teduglutide increases villus height and crypt depth in the small bowel mucosa, promoting nutrition absorption and enteral independence from parenteral nutrition (PN). We aim to report our single-center experience with teduglutide in adult patients with SBS to provide real-world context to its use.
We conducted a retrospective analysis on patients managed within our tertiary-level intestinal rehabilitation program to identify patients with SBS-IF treated with teduglutide from 2009-2015. The current report includes all patients at our center who had any exposure to teduglutide, including those who received commercial drug after approval by the Food and Drug Administration (FDA) and outside the scope of clinical trials.
A total of 18 patients were treated with teduglutide. Eleven patients (61%) achieved complete enteral independence from PN and/or intravenous fluids (IV) at a median time of 10 months (range: 3-36 months). PN/IV volume requirement was reduced in all patients except two. Ten of the 11 patients (91%) who achieved enteral autonomy had colon. All patients off PN/IV required additional oral vitamins and electrolyte supplementations.
Our preliminary experience is consistent with prior reports of successful partial or complete weaning from PN/IV with teduglutide treatment in adult patients with SBS. The presence of colon appears to be favorable in obtaining enteral independence from PN/IV, regardless of residual small bowel length. Patients on teduglutide may remain at high risk of micronutrient deficiencies.
特迪格鲁肽是一种胰高血糖素样肽 2（GLP-2）类似物，已被批准用于治疗成人短肠综合征（SBS）相关的肠衰竭（IF；SBS-IF）。特迪格鲁肽可增加小肠黏膜的绒毛高度和隐窝深度，促进营养吸收和肠内营养（EN）独立于肠外营养（PN）。我们旨在报告我们在成人 SBS 患者中使用特迪格鲁肽的单中心经验，为其使用提供真实世界的背景。
我们对我们的三级肠道康复计划中管理的患者进行了回顾性分析，以确定在 2009 年至 2015 年期间接受特迪格鲁肽治疗的 SBS-IF 患者。本报告包括我们中心所有接受过特迪格鲁肽治疗的患者，包括那些在食品和药物管理局（FDA）批准后接受商业药物治疗的患者和临床试验范围之外的患者。
共有 18 名患者接受了特迪格鲁肽治疗。11 名患者（61%）在中位数为 10 个月（范围：3-36 个月）的时间内实现了完全从 PN 和/或静脉输液（IV）过渡到完全经口进食。除 2 名患者外，所有患者的 PN/IV 量需求均减少。11 名实现经口进食的患者中有 10 名（91%）有结肠。所有停止 PN/IV 的患者均需要额外的口服维生素和电解质补充剂。
我们的初步经验与先前报道的在成人 SBS 患者中使用特迪格鲁肽治疗成功实现部分或完全从 PN/IV 脱机的经验一致。无论残留小肠长度如何，存在结肠似乎有利于从 PN/IV 获得经口进食的独立性。接受特迪格鲁肽治疗的患者仍存在微量元素缺乏的高风险。
