Siu Rex K, Karime Christian, Hashash Jana G, Kinnucan Jami, Picco Michael F, Farraye Francis A
Department of Medicine, Mayo Clinic, Jacksonville, FL, USA.
Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.
Crohns Colitis 360. 2024 Jan 24;6(1):otae007. doi: 10.1093/crocol/otae007. eCollection 2024 Jan.
Crohn's disease (CD) with short bowel syndrome (SBS) can present as chronic intestinal failure (CIF) often requiring nutritional support. Teduglutide is a treatment option for these patients. We investigated clinical outcomes of CD-CIF patients with SBS treated with teduglutide.
Adults with CD-CIF and SBS who received teduglutide were identified at a tertiary care academic center between 2012 and 2023. Data was collected retrospectively. Primary outcome measured was reduction in parenteral support (PS) by ≥20% volume, with PS defined as utilization of parenteral nutrition (PN) or intravenous fluids (IVF). Several secondary outcomes included immunosuppressive medication changes, subjective symptom improvement, and stool output.
We identified 32 patients with CD-CIF and SBS receiving teduglutide. Comparing clinical outcomes before and after teduglutide, 26 of 32 patients achieved the primary outcome of ≥20% PS reduction. A decrease was seen in patients requiring PN + IVF, with corresponding increases in patients requiring PN only and IVF only. Among all 3 groups, a total of 23 patients received PN prior to teduglutide, which decreased to 14 following teduglutide. Weekly PN volume reduced from 7.00 to 3.55 L and weekly frequency decreased from 7.00 to 3.00 instances ( < .01). Reductions in weekly volume and frequency were observed among all patients receiving IVF support (25 vs 15). Secondary outcomes showed improvement in patient reported subjective symptoms (84.4%), stool output (90.6%), patients meeting criteria for diarrhea/high ostomy output (27 vs 14), and use of unique antidiarrheal medications (3.0 vs 2.0).
This retrospective case series demonstrated improved clinical outcomes in patients with CD-CIF and SBS treated with teduglutide resulting in decreased PS requirements, antidiarrheal medications requirement, and stool output without significant effects on immunosuppressive therapy.
克罗恩病（CD）合并短肠综合征（SBS）可表现为慢性肠衰竭（CIF），常需要营养支持。替度鲁肽是这些患者的一种治疗选择。我们研究了接受替度鲁肽治疗的CD-CIF合并SBS患者的临床结局。
在2012年至2023年期间，在一家三级医疗学术中心确定了接受替度鲁肽治疗的成年CD-CIF合并SBS患者。数据进行回顾性收集。主要结局指标为肠外支持（PS）量减少≥20%，PS定义为肠外营养（PN）或静脉输液（IVF）的使用。几个次要结局包括免疫抑制药物的变化、主观症状改善和粪便排出量。
我们确定了32例接受替度鲁肽治疗的CD-CIF合并SBS患者。比较替度鲁肽治疗前后的临床结局，32例患者中有26例达到了PS减少≥20%的主要结局。需要PN+IVF的患者减少，而仅需要PN和仅需要IVF的患者相应增加。在所有3组中，共有23例患者在使用替度鲁肽之前接受PN治疗，使用替度鲁肽后降至14例。每周PN量从7.00 L降至3.55 L，每周使用次数从7.00次降至3.00次（<0.01）。在所有接受IVF支持的患者中，每周量和使用次数均有减少（25次对15次）。次要结局显示患者报告的主观症状（84.4%）、粪便排出量（90.6%）、符合腹泻/高造口排出量标准的患者（27例对14例）以及独特止泻药物的使用（3.0次对2.0次）均有改善。
这个回顾性病例系列表明，接受替度鲁肽治疗的CD-CIF合并SBS患者临床结局得到改善，导致PS需求、止泻药物需求和粪便排出量减少，且对免疫抑制治疗无显著影响。
