Use of Teduglutide in Children With Intestinal Failure: A Systematic Review

Overview

Journal Front Nutr

Specialty Nutritional Sciences

Date 2022 Jul 1

PMID 35774551

Authors

Francesca Gigola

Maria Chiara Cianci

Roberto Cirocchi

Maria Chiara Ranucci

Marco Del Riccio

Riccardo Coletta

Antonino Morabito

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Short-bowel syndrome (SBS) results from the loss of a significant portion of the small intestine leading to a state of malabsorption. After an intestinal loss, there is a process of adaptation involving the Glucagon-Like Peptide-2 (GLP-2), an enteroendocrine peptide also involved in nutrient absorption. Teduglutide is a recombinant analog of GLP-2 approved in 2016 to treat selected SBS pediatric patients who are dependent on parenteral support. The present systematic review aims to evaluate the efficacy of Teduglutide in pediatric patients with SBS in reducing the need for parenteral nutrition (PN).

Materials And Methods: We performed a literature search on MEDLINE and Embase to include articles up to November 2021. We included articles that involved using Teduglutide in the SBS pediatric population to define its efficacy in reducing the need for PN. The key words used were GLP-2, teduglutide, child.

Results: Fourteen studies completely fulfilled the inclusion criteria. Two hundred 23 patients were treated with Teduglutide, and the median duration of treatment was 45 weeks (IQR: 36-52.5 weeks). One-hundred and fifty-two patients were treated with 0.05 mg/Kg/d of subcutaneous Teduglutide, 38 received 0.025 mg/Kg/d and 8 received either 0.125 mg/Kg/d or 0.20 mg/Kg/d. A total of 36 patients achieved enteral autonomy (EA) after a median of 24 weeks of treatment (IQR: 24-48 weeks) and 149 patients showed a reduction in PN needs in terms of volume, calories, or hours per day. Eleven studies reported complications: gastrointestinal were the most common, with 89 cases reported in treated patients and 11 in non-treated patients.

Conclusion: Teduglutide appears safe and effective in reducing PN requirements and improving EA in the pediatric population. However, more studies are needed to understand its efficacy in the long term and after discontinuation and possible complications.

Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42022301593].

Citing Articles

Pediatric Chronic Intestinal Failure: Something Moving?.

Demirok A, Nagelkerke S, Benninga M, Jonkers-Schuitema C, van Zundert S, Werner X Nutrients. 2024; 16(17).

PMID: 39275281 PMC: 11397488. DOI: 10.3390/nu16172966.

Spring-mediated distraction enterogenesis may alter the course of adaptation in porcine short bowel syndrome.

Bautista G, Dubrovsky G, Sweeney N, Solorzano-Vargas R, Tancredi D, Lewis M Front Gastroenterol (Lausanne). 2024; 3.

PMID: 39044860 PMC: 11265786. DOI: 10.3389/fgstr.2024.1292226.

Evaluation of the Effectiveness of Teduglutide Treatment in Patients with Short Bowel Syndrome in Slovakia-Multicenter Real-World Study.

Gombosova L, Suchansky M, Krivus J, Hornova J, Havlicekova Z, Fojtova A J Clin Med. 2024; 13(5).

PMID: 38592065 PMC: 10931580. DOI: 10.3390/jcm13051238.

Treatment of Food Aversion and Eating Problems in Children with Short Bowel Syndrome: A Systematic Review.

Gigola F, Carletti V, Coletta R, Certini M, Riccio M, Bortolotti C Children (Basel). 2022; 9(10).

PMID: 36291518 PMC: 9600729. DOI: 10.3390/children9101582.

References

Bianchi A, Morabito A . The dilated bowel: a liability and an asset. Semin Pediatr Surg. 2009; 18(4):249-57. DOI: 10.1053/j.sempedsurg.2009.07.010. View

Struijs M, Diamond I, de Silva N, Wales P . Establishing norms for intestinal length in children. J Pediatr Surg. 2009; 44(5):933-8. DOI: 10.1016/j.jpedsurg.2009.01.031. View

Jeppesen P, Sanguinetti E, Buchman A, Howard L, Scolapio J, Ziegler T . Teduglutide (ALX-0600), a dipeptidyl peptidase IV resistant glucagon-like peptide 2 analogue, improves intestinal function in short bowel syndrome patients. Gut. 2005; 54(9):1224-31. PMC: 1774653. DOI: 10.1136/gut.2004.061440. View

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

Boluda E, Redecillas Ferreiro S, Manrique Moral O, Garcia Romero R, Irastorza Terradillos I, Nunez Ramos R . Experience With Teduglutide in Pediatric Short Bowel Syndrome: First Real-life Data. J Pediatr Gastroenterol Nutr. 2020; 71(6):734-739. DOI: 10.1097/MPG.0000000000002899. View

Spencer A, Kovacevich D, McKinney-Barnett M, Hair D, Canham J, Maksym C . Pediatric short-bowel syndrome: the cost of comprehensive care. Am J Clin Nutr. 2008; 88(6):1552-9. DOI: 10.3945/ajcn.2008.26007. View

Bianchi A . Intestinal loop lengthening--a technique for increasing small intestinal length. J Pediatr Surg. 1980; 15(2):145-51. DOI: 10.1016/s0022-3468(80)80005-4. View

Bremholm L, Hornum M, Henriksen B, Larsen S, Holst J . Glucagon-like peptide-2 increases mesenteric blood flow in humans. Scand J Gastroenterol. 2008; 44(3):314-9. DOI: 10.1080/00365520802538195. View

Sterne J, Hernan M, Reeves B, Savovic J, Berkman N, Viswanathan M . ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016; 355:i4919. PMC: 5062054. DOI: 10.1136/bmj.i4919. View

10.

Gattini D, Roberts A, Wales P, Beath S, Evans H, Hind J . Trends in Pediatric Intestinal Failure: A Multicenter, Multinational Study. J Pediatr. 2021; 237:16-23.e4. DOI: 10.1016/j.jpeds.2021.06.025. View

11.

Coletta R, Aldeiri B, Morabito A . Institutional Experience with Spiral Intestinal Lengthening and Tailoring. Eur J Pediatr Surg. 2018; 29(5):412-416. DOI: 10.1055/s-0038-1660850. View

12.

Quiros-Tejeira R, Ament M, Reyen L, Herzog F, Merjanian M, Olivares-Serrano N . Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome: a 25-year experience. J Pediatr. 2004; 145(2):157-63. DOI: 10.1016/j.jpeds.2004.02.030. View

13.

Fragkos K, Forbes A . Citrulline as a marker of intestinal function and absorption in clinical settings: A systematic review and meta-analysis. United European Gastroenterol J. 2018; 6(2):181-191. PMC: 5833233. DOI: 10.1177/2050640617737632. View

14.

Carter B, Cohran V, Cole C, Corkins M, Dimmitt R, Duggan C . Outcomes from a 12-Week, Open-Label, Multicenter Clinical Trial of Teduglutide in Pediatric Short Bowel Syndrome. J Pediatr. 2016; 181:102-111.e5. DOI: 10.1016/j.jpeds.2016.10.027. View

15.

Sigalet D, Brindle M, Boctor D, Casey L, Dicken B, Butterworth S . Safety and Dosing Study of Glucagon-Like Peptide 2 in Children With Intestinal Failure. JPEN J Parenter Enteral Nutr. 2015; 41(5):844-852. DOI: 10.1177/0148607115609566. View

16.

Massironi S, Cavalcoli F, Rausa E, Invernizzi P, Braga M, Vecchi M . Understanding short bowel syndrome: Current status and future perspectives. Dig Liver Dis. 2020; 52(3):253-261. DOI: 10.1016/j.dld.2019.11.013. View

17.

Muto M, Kaji T, Onishi S, Yano K, Yamada W, Ieiri S . An overview of the current management of short-bowel syndrome in pediatric patients. Surg Today. 2021; 52(1):12-21. DOI: 10.1007/s00595-020-02207-z. View

18.

Nagelkerke S, van Oers H, Haverman L, Vlug L, de Koning B, Benninga M . Longitudinal Development of Health-related Quality of Life and Fatigue in Children on Home Parenteral Nutrition. J Pediatr Gastroenterol Nutr. 2021; 74(1):116-122. PMC: 8673843. DOI: 10.1097/MPG.0000000000003329. View

19.

Fonseca G, Burgermaster M, Larson E, Seres D . The Relationship Between Parenteral Nutrition and Central Line-Associated Bloodstream Infections: 2009-2014. JPEN J Parenter Enteral Nutr. 2018; 42(1):171-175. PMC: 5568511. DOI: 10.1177/0148607116688437. View

20.

Crenn P, Messing B, Cynober L . Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction. Clin Nutr. 2008; 27(3):328-39. DOI: 10.1016/j.clnu.2008.02.005. View