Teduglutide therapy in children, six years of experience in a specialized Intestinal Rehabilitation Unit
TRANSPLANTATION(2023)
Abstract
Introduction: Management of intestinal failure (IF) secondary to short bowel syndrome aims to achieve enteral autonomy and to prevent parenteral nutrition (PN) related complications. Intestinal rehabilitation is accomplished using a combination of different strategies (medical, surgical, and nutritional). A semisynthetic GLP-2 analogue, teduglutide (TED), is an enterohormone that has been recently added to the IF treatment options for children; experience with its use is still limited. Aim: to describe the results of using TED treatment in children with Type III-IF (IF) due to short gut syndrome. Methods: Retrospective descriptive study in patients < 18 years treated with TED 0.05 mg/kg/day from 1/2017 to 1/2022 performed at a single center in Argentina. SPSS v24.0 was used for statistical analysis, continuous variables were expressed as median and interquartile range (M/IQR), and Wilcoxon test was used to compare variables between initial and end points. Results: 10 patients are described, 5 with neonatal onset of IF (congenital GI anomalies) and 5 with childhood onset of IF (3 volvulus, 1 post-surgical complications and 1 trauma). M/IQR time of IF before TED initiation was 6 (2.5/11.7) years; M/IQR residual intestinal length was 18(8.5/21.5) cm, 3 patients had ICV and intact colon. M/IQR time of TED treatment was 1.7 (0.8/4.1) years. At last follow up 4 patients had electively discontinued parenteral nutrition (PN) at weeks 24, 29, 48 and 186 of TED therapy, and one discontinued at week 168 due to loss of conventional vascular access; one of them electively discontinued TED at week 260, and other 2 are on TED alternating days. The additional 5 patients continue on PN and daily TED, with a reduction on PN support of 26.5% (expressed as ratio between non protein energy intake/ resting energy expenditure) from baseline: M 0.85 (IQR:0.7/1.23) to 0.71 (IQR: 0.52/0.91) (p=0.059); and number of days of PN infusion/week from 6 (IQR: 5/6.5) to 4.8(4/5.5) (p 0.068). Overall Nutritional data is presented in table 1. Adverse events occurred were: abdominal pain in 8 patients, pain/bruises at injection site in 5, transient diarrhea in 5 mild hyperamylasemia in 4, low serum bicarbonate in 4, mild anemia in 3, hypomagnesemia in 2, low Vitamin D levels in 8, recurrent lower GI bleeding in 1 (due to anastomotic ulcers, diagnosed prior to TED initiation), positive fecal occult blood with negative endoscopy findings in 1, cholesterolosis in 1 and cholecystitis in 1. Conclusion: the use TED therapy allowed achieving intestinal rehabilitation or reduction on PN support with no impact on the nutritional status, in a group of patients unable to obtain further progress with standard medical rehabilitation. The adverse events were similar to those reported in the adult population.
MoreTranslated text
Key words
teduglutide therapy,rehabilitation
AI Read Science
Must-Reading Tree
Example
Generate MRT to find the research sequence of this paper
Chat Paper
Summary is being generated by the instructions you defined