Efficacy of Teduglutide for Parenteral Support Reduction in Patients with Short Bowel Syndrome: A Systematic Review and Meta-Analysis

Abstract

Teduglutide has been described as an effective treatment for parenteral support (PS) reduction in patients with short bowel syndrome (SBS). However, a quantitative summary of the available evidence is still lacking. PubMed/Medline, EMBASE, Cochrane library, OVID, and CINAHL databases were systematically searched up to July 2021 for studies reporting the rate of response (defined as a ≥20% reduction in PS) to teduglutide among PS-dependent adult patients. The rate of weaning (defined as the achievement of PS independence) was also evaluated as a secondary end-point. Ten studies were finally considered in the meta-analysis. Pooled data show a response rate of 64% at 6 months, 77% at 1 year and, 82% at ≥2 years; on the other hand, the weaning rate could be estimated as 11% at 6 months, 17% at 1 year, and 21% at ≥2 years. The presence of colon in continuity reduced the response rate (−17%, 95%CI: (−31%, −3%)), but was associated with a higher weaning rate (+16%, 95%CI: (+6%, +25%)). SBS etiology, on the contrary, was not found to be a significant predictor of these outcomes, although a nonsignificant trend towards both higher response rates (+9%, 95%CI: (−8%, +27%)) and higher weaning rates (+7%, 95%CI: (−14%, +28%)) could be observed in patients with Crohn’s disease. This was the first meta-analysis that specifically assessed the efficacy of teduglutide in adult patients with SBS. Our results provide pooled estimates of response and weaning rates over time and identify intestinal anatomy as a significant predictor of these outcomes.

Malnutrition with Low Muscle Mass Is Common after Weaning off Home Parenteral Nutrition for Chronic Intestinal Failure

“…Despite a median SB length of ≤60 cm (52.5 cm), a stable nutritional status was noted after weaning [ 33 ]. Besides the lower response but higher weaning rates in those with a remnant colon, the highest IVS volume increase within one year from discontinuation of TED was found in the SBS-JC patients [ 34 , 35 ]. Although the response rates of TED are based on improved wet weight absorption and IVS volume reduction, the outcomes are also dependent on colonic energy absorption.…”

IFALD in children: What's new? A narrative review

“…Significantly more patients with SBS-IF treated with teduglutide than those on SOC achieved the primary end point of a 20% reduction in parenteral support volume at week 24 ( 75 ). Bioletto et al ( 77 ) in their meta-analysis showed a response rate of 64% at 6 months, 77% at 1 year, and 82% at ≥2 years in adult patients with SBS whereas the weaning rate was estimated as 11% at 6 months, 17% at 1 year, and 21% at ≥2 years. Intestinal anatomy was identified as a significant predictor of outcomes.…”

Is the Use of Artificial Sweeteners Beneficial for Patients with Diabetes Mellitus? The Advantages and Disadvantages of Artificial Sweeteners

“…GLP-2 is thought to contribute to homeostatic signals such as the promotion of nutrient absorption and the maintenance and repair of the intestinal mucosa; patients with digestive disorders who have residual GLP-2-secreting cells may benefit from short-term artificial sweetener administration. As teduglutide, a GLP-2 analog, is beneficial for parenteral support (PS) reduction in patients with short bowel syndrome, especially Crohn’s disease [ 54 ], artificial sweeteners might be effective for the treatment of digestive diseases.…”