Intestinal failure (IF) describes the state of a person's gastrointestinal absorption capabilities becoming unable to absorb fluids and nutrients needed to sustain normal physiology, leading to severe comorbidities and if left untreated, to death
- IF is most commonly seen as a result of short bowel syndrome (SBS)
- short bowel syndrome (SBS) is a heterogenic medical condition in which patients suffer from an impaired intestinal absorption due to either a loss of bowel after surgical resection or a loss of bowel function due to congenital defects or disease-related destruction of the bowel
- after surgery, depending on the resection site and the remaining bowel length, patients either suffer from intestinal insufficiency, or develop intestinal failure (SBS-IF)
- patients with intestinal insufficiency are able to compensate for the loss of bowel either physiologically or with pharmacological or nutritional support, while for patients with SBS-IF parenteral support (PS) is vital
Teduglutide is specifically indicated for patients with short bowel syndrome who are dependent on parenteral nutrition (1)
- is an analogue of glucagon-like peptide-2 (GLP-2), which is a peptide hormone secreted by L cells in the distal bowel. Teduglutide activates GLP-2 receptors in the gut and causes release of insulin-like growth factor, nitric oxide and keratinocyte growth factor
- promotes repair and normal growth of the intestinal mucosa by increasing villi height and crypt depth
- is used daily by subcutaneous injection in a dose of 0.05 mg/kg and leads to the growth of intestinal mucosa by stimulating intestinal crypt cell growth and inhibiting enterocyte apoptosis, thereby leading to an increased intestinal surface (2)
- common side effects of therapy include intestinal obstruction, biliary and pancreatic disease, fluid imbalance, and increased absorption of oral medications (2)
NICE state (3):
- Teduglutide is recommended, within its marketing authorisation, as an option for treating short bowel syndrome (SBS) in people 1 year and above. People's condition should be stable following a period of intestinal adaptation after surgery before having teduglutide. Teduglutide is recommended only if the company provides it according to the commercial arrangement.
Reference:
- Teduglutide for short bowel syndrome. Aust Prescr. 2020 Apr;43(2):72-73. doi: 10.18773/austprescr.2020.017. Epub 2020 Mar 3. PMID: 32346219; PMCID: PMC7186272.
- Schlager L, Stift A, Gartner J, Hütterer E, Harpain F. Bridging intestinal failure with Teduglutide - A case report. International Journal of Surgery Case Reports. 2021 Sep;86:106270. DOI: 10.1016/j.ijscr.2021.106270. PMID: 34418803; PMCID: PMC8384933.
- NICE (June 2022). Teduglutide for treating short bowel syndrome