Postsurgical Intestinal Rehabilitation Using Semisynthetic Glucagon‐Like Peptide‐2 Analogue (sGLP‐2) at a Referral Center: Can Patients Achieve Parenteral Nutrition and sGLP‐2 Independency?

Abstract

Background Teduglutide, a semisynthetic analogue of glucagon‐like peptide‐2 (sGLP‐2), increases intestinal absorption of fluids and nutrients, reducing the need for parenteral nutrition (PN). This report aims to describe our experience with sGLP‐2 in a cohort of adult patients with short‐bowel syndrome. Methods This is a prospective observational study on adult patients initially evaluated in our specialized intestinal rehabilitation program that received sGLP‐2 from June 2014 to March 2020. Results Autologous gastrointestinal reconstruction surgery (AGIRS) was performed in 108 patients; 68.5% (74 of 108) achieved intestinal sufficiency with standard medical therapy. Seventeen patients were treated with sGLP‐2; 66.5% (8 of 12) received treatment for a mean time of 25.8 weeks (3.4–54.0) and could suspend PN. One patient reinitiated treatment due to renal lithiasis and acute renal failure. Currently, 7 of 12 patients (53.8%) continue without PN for a mean time of 165.6 weeks. Volume, energy, and days of PN were reduced in all patients. No serious adverse events were registered. Four of 7 patients (57.1%) who discontinued PN could also discontinue sGLP‐2. Therefore, the use of sGLP‐2 increased the overall success rate of PN independency after AGIRS to 76% (82 of 108). Conclusion This study confirmed that sGLP‐2 should be considered as part of the standard therapy for postsurgical medical rehabilitation treatment in patients with chronic intestinal failure. We add to the current knowledge that some patients can discontinue both PN and sGLP‐2 in the long term, achieving complete recovery of their quality of life.

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

“…An accurate title or abstract revision was sufficient to exclude 401 articles as not pertinent or not fulfilling our prespecified inclusion or exclusion criteria. The remaining 34 studies were assessed in full-text for eligibility; 10 of them finally met all criteria for being included in the final analysis [27,28,[43][44][45][46][47][48][49][50]; 2 additional post hoc analyses were employed for data extraction [35,37], as they contained additional and relevant information for the assessment of the outcomes of 3 among the 10 pertinent papers [28,45,49]. The process of study selection is summarized in Figure 1.…”

“…Table 1 summarizes the basic study characteristics. Two studies had a randomized, placebo-controlled, double-blinded design [27,28]; the remaining eight studies were characterized by an observational design [43][44][45][46][47][48][49][50]. Among these, one was actually designed as a randomized controlled trial (RCT) [45], but the randomization and the blindness of treatment assignment was performed between different teduglutide dosing schedules rather than between the teduglutide and placebo; therefore, to the scope of our analyses, this study falls in the group of "observational" ones, since both the investigators and the patients were aware that a treatment with the drug was actually in place.…”

Rehabilitación del intestino utilizando un Análogo Semisintético del Péptido 2 similar al Glucagón (sGLP-2). Primera experiencia con Teduglutide en Uruguay.

“…Actualmente en centros de referencia, únicamente aquellos pacientes que no pudieron continuar reduciendo el volumen de NPD en un período de aproximadamente 6 meses, son evaluados para iniciar sGLP-2. Existen fórmulas predictivas disponibles para estimar la probabilidad de destete de la NPD en este grupo de pacientes, lo que facilita una evaluación objetiva que evita indicaciones inadecuadas de un medicamento de alto costo (11,12,27) . Las células L intestinales enteroendocrinas producen proglucagón que se escinde para formar glucagón, así como múltiples fragmentos de péptido derivado de proglucagón (PGDP), incluidos el péptido 1 similar al glucagón (GLP-1) y el péptido 2 similar al glucagón (GLP-2), denominados así porque comparten aproximadamente el 50% de los mismos aminoácidos que el glucagón (28) .…”

“…Estos cambios estructurales y funcionales a nivel intestinal son los que han permitido reducir o eliminar la dependencia a la NP en hasta 60% de los pacientes con una media de 50 semanas de tratamiento, así como ocurrió con el caso que presentamos (31)(32)(33)(34)(35)(36) . Los pacientes se consideran "respondedores tempranos" si el volumen de NP se reduce más del 20% del valor inicial antes de la semana 24, y "respondedores tardíos" si la respuesta positiva ocurre después de 24 semanas de tratamiento con sGLP-2 (27) . Nuestro paciente logró reducir un 25% del volumen de NPD a la semana 8, sin presentar efectos adversos signi-Rehabilitación del intestino utilizando un sGLP2 | Moreira E et al 6 Figura 1B.…”

“…Según resultados alentadores recientemente publicados, aproximadamente la mitad de los pacientes que ya no recibían NPD pudieron interrumpir el tratamiento con sGLP-2, con un tiempo medio de tratamiento posterior de 63,5 semanas (DE ± 45,2). Manteniendo el peso, estado funcional, diuresis, número de deposiciones y estabilidad del medio interno, probablemente vinculado a su efecto acumulativo (27) .…”