Management Patterns of Teduglutide Use in Short Bowel Syndrome: A Survey of 70 Healthcare Professionals

Overview

Journal Nutrients

Date 2024 Nov 9

PMID 39519595

Authors

Felix Harpain

Slobodan Milicevic

Lucy Howard

Patricia Biedermann

Ulrich-Frank Pape

Affiliations

Soon will be listed here.

Abstract

Background: This study aimed to gain real-world insights from healthcare professionals (HCPs) regarding the management of adult patients with short bowel syndrome and intestinal failure (SBS-IF) who received teduglutide and achieved parenteral support (PS) independence or PS volume stability for ≥12 months.

Methods: This cross-sectional survey was conducted in five European countries and Canada via a self-reported questionnaire (November 2022-March 2023) among HCPs who manage patients with SBS-IF and who had prescribed teduglutide to ≥5 patients with SBS-IF receiving PS.

Results: Of the 70 HCPs who completed the survey, almost all reported managing patients with SBS-IF who achieved PS independence or PS volume stability (99%, 69/70 and 97%, 68/70, respectively) and maintained the standard teduglutide dose, without changes. A total of 52 HCPs managed patients who achieved PS independence and discontinued teduglutide. Of these HCPs, 73% (38/52) anticipated that these patients would remain PS-independent, not requiring PS reintroduction. Of the remainder, 79% (11/14) estimated that ≤40% of these patients would require PS reintroduction. While many HCPs (81%, 42/52) would reintroduce teduglutide in patients who discontinued its use after achieving PS independence, none would do so for patients who discontinued teduglutide after achieving PS volume stability if a patient's condition worsened.

Conclusions: This survey found that patients with SBS-IF can achieve PS independence or PS volume stability with teduglutide treatment. However, some HCPs (27%, 14/52) believe that a proportion of patients discontinuing teduglutide after achieving PS independence will require PS reintroduction. This survey suggests that teduglutide treatment should continue uninterrupted, unless clinically indicated, but this requires confirmation in future studies.

References

Seidner D, Fujioka K, Boullata J, Iyer K, Lee H, Ziegler T . Reduction of Parenteral Nutrition and Hydration Support and Safety With Long-Term Teduglutide Treatment in Patients With Short Bowel Syndrome-Associated Intestinal Failure: STEPS-3 Study. Nutr Clin Pract. 2018; 33(4):520-527. DOI: 10.1002/ncp.10092. View

Buttner J, Bluthner E, Greif S, Kuhl A, Elezkurtaj S, Ulrich J . Predictive Potential of Biomarkers of Intestinal Barrier Function for Therapeutic Management with Teduglutide in Patients with Short Bowel Syndrome. Nutrients. 2023; 15(19). PMC: 10574292. DOI: 10.3390/nu15194220. 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

Messing B, Crenn P, Beau P, Boutron-Ruault M, Rambaud J, Matuchansky C . Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome. Gastroenterology. 1999; 117(5):1043-50. DOI: 10.1016/s0016-5085(99)70388-4. View

Joly F, Seguy D, Nuzzo A, Chambrier C, Beau P, Poullenot F . Six-month outcomes of teduglutide treatment in adult patients with short bowel syndrome with chronic intestinal failure: A real-world French observational cohort study. Clin Nutr. 2020; 39(9):2856-2862. DOI: 10.1016/j.clnu.2019.12.019. View

Kelly D, Tappenden K, Winkler M . Short bowel syndrome: highlights of patient management, quality of life, and survival. JPEN J Parenter Enteral Nutr. 2013; 38(4):427-37. DOI: 10.1177/0148607113512678. View

Ukleja A, To C, Alvarez A, Lara L . Long-Term Therapy With Teduglutide in Parenteral Support-Dependent Patients With Short Bowel Syndrome: A Case Series. JPEN J Parenter Enteral Nutr. 2018; 42(4):821-825. DOI: 10.1002/jpen.1149. View

Bluthner E, Pape U, Tacke F, Greif S . Quality of Life in Teduglutide-Treated Patients with Short Bowel Syndrome Intestinal Failure-A Nested Matched Pair Real-World Study. Nutrients. 2023; 15(8). PMC: 10144575. DOI: 10.3390/nu15081949. View

Puello F, Wall E, Herlitz J, Lozano E, Semrad C, Micic D . Long-Term Outcomes With Teduglutide From a Single Center. JPEN J Parenter Enteral Nutr. 2020; 45(2):318-322. DOI: 10.1002/jpen.1838. View

10.

de Dreuille B, Nuzzo A, Bataille J, Mailhat C, Billiauws L, Le Gall M . Post-Marketing Use of Teduglutide in a Large Cohort of Adults with Short Bowel Syndrome-Associated Chronic Intestinal Failure: Evolution and Outcomes. Nutrients. 2023; 15(11). PMC: 10255523. DOI: 10.3390/nu15112448. View

11.

Pironi L, Cuerda C, Jeppesen P, Joly F, Jonkers C, Krznaric Z . ESPEN guideline on chronic intestinal failure in adults - Update 2023. Clin Nutr. 2023; 42(10):1940-2021. DOI: 10.1016/j.clnu.2023.07.019. View

12.

Lam K, Schwartz L, Batisti J, Iyer K . Single-Center Experience with the Use of Teduglutide in Adult Patients with Short Bowel Syndrome. JPEN J Parenter Enteral Nutr. 2018; 42(1):225-230. DOI: 10.1002/jpen.1011. View

13.

Schwartz L, OKeefe S, Fujioka K, Gabe S, Lamprecht G, Pape U . Long-Term Teduglutide for the Treatment of Patients With Intestinal Failure Associated With Short Bowel Syndrome. Clin Transl Gastroenterol. 2016; 7:e142. PMC: 4817413. DOI: 10.1038/ctg.2015.69. View

14.

Pironi L, Allard J, Joly F, Geransar P, Genestin E, Pape U . Use of teduglutide in adults with short bowel syndrome-associated intestinal failure. Nutr Clin Pract. 2023; 39(1):141-153. DOI: 10.1002/ncp.11015. View

15.

Harpain F, Schlager L, Hutterer E, Dawoud C, Kirchnawy S, Stift J . Teduglutide in short bowel syndrome patients: A way back to normal life?. JPEN J Parenter Enteral Nutr. 2021; 46(2):300-309. PMC: 9298195. DOI: 10.1002/jpen.2272. View

16.

Berghofer P, Fragkos K, Baxter J, Forbes A, Joly F, Heinze H . Development and validation of the disease-specific Short Bowel Syndrome-Quality of Life (SBS-QoL™) scale. Clin Nutr. 2013; 32(5):789-96. DOI: 10.1016/j.clnu.2012.12.001. View

17.

Jeppesen P, Pertkiewicz M, Messing B, Iyer K, Seidner D, OKeefe S . Teduglutide reduces need for parenteral support among patients with short bowel syndrome with intestinal failure. Gastroenterology. 2012; 143(6):1473-1481.e3. DOI: 10.1053/j.gastro.2012.09.007. View

18.

Bioletto F, DEusebio C, Merlo F, Aimasso U, Ossola M, Pellegrini M . Efficacy of Teduglutide for Parenteral Support Reduction in Patients with Short Bowel Syndrome: A Systematic Review and Meta-Analysis. Nutrients. 2022; 14(4). PMC: 8880479. DOI: 10.3390/nu14040796. View

19.

Jeppesen P, Gilroy R, Pertkiewicz M, Allard J, Messing B, OKeefe S . Randomised placebo-controlled trial of teduglutide in reducing parenteral nutrition and/or intravenous fluid requirements in patients with short bowel syndrome. Gut. 2011; 60(7):902-14. PMC: 3112364. DOI: 10.1136/gut.2010.218271. View

20.

Klek S, Kunecki M, Sobocki J, Matysiak K, Karwowska K, Urbanowicz K . The Polish Intestinal Failure Centres' consensus on the use of teduglutide for the treatment of short bowel syndrome. Nutrition. 2017; 38:28-33. DOI: 10.1016/j.nut.2016.12.022. View