Pharmacologic Options for Intestinal Rehabilitation in Patients With Short Bowel Syndrome

Abstract

A primary goal of intestinal rehabilitation programs is to facilitate intestinal adaptation. Adult patients with short bowel syndrome (SBS) who are dependent on parenteral nutrition and/or intravenous fluid (PN/IV) support have 2 hormonal pharmacologic treatment options available that may promote intestinal growth: a glucagon-like peptide 2 analog (teduglutide) and recombinant human growth hormone (somatropin). In two phase III clinical trials (N=169), 24 weeks of teduglutide administered to outpatients with SBS resulted in significant decreases in PN/IV volume requirements of 2.5-4.4 L/wk. In an extension study of one of these trials, patients with SBS who completed 30 months of teduglutide experienced a mean PN/IV reduction of 7.6 L/wk from baseline. Furthermore, some patients achieved independence from PN/IV support. The most common adverse events associated with teduglutide treatment in clinical trials were gastrointestinal symptoms, including abdominal distension, abdominal pain, and nausea. This safety profile is consistent with the associated underlying diseases leading to SBS or the known mechanism of action of teduglutide. A single phase III study (N=41) evaluated the safety and efficacy of a 4-week inpatient course of somatropin in combination with a glutamine-supplemented diet for adults with SBS. Somatropin treatment significantly reduced parenteral support requirements by 1.1 L/d in these patients. The most common adverse events were peripheral edema and musculoskeletal events. Large-scale, long-term follow-up studies of somatropin for SBS have not been conducted. Although treatment for patients with SBS must be individualized, teduglutide and somatropin are positive extensions to existing fluid and nutrient management strategies.

Acute Effects of a Glucagon‐Like Peptide 2 Analogue, Teduglutide, on Gastrointestinal Motor Function and Permeability in Adult Patients With Short Bowel Syndrome on Home Parenteral Nutrition

“…Overall, it is possible that TED's intestinotrophic and hormonal mediated effects, such as retardation of intestinal transit and decreased intestinal secretions, may explain the acute effects on fluid balance within days of administration. TED's profile of clinical benefits appears promising for patients with SBS whose goal is to improve quality of life by increasing the absorptive potential of the remnant intestine and, thus, decreasing or eliminating the use of PN 34 …”

Glucagon-Like Peptide-2 Regulates Release of Chylomicrons From the Intestine

“…9,10 The GLP-2 analogue teduglutide is now approved in a number of countries for treatment of this condition. 6,11 Only 1 study has previously examined the effects of GLP-2 on plasma lipids in human beings. 12 Intravenous infusion of native GLP-2 was shown to increase postprandial plasma TG and free fatty acid (FFA) concentrations.…”

Choice of Allograft in Patients Requiring Intestinal Transplantation: A Critical Review

“…The first step of intestinal rehabilitation is usually proper dietary management and adjunctive medications [20, 21]. In general, such patients benefit from hyperphagia to compensate for their malabsorptive state.…”