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Presenter: Kwai, Lam, New York, United States
Authors: Kwai Lam, Lauren Schwartz, Jennifer Batisti, Kishore Iyer
Kwai Lam1, Lauren Schwartz2, Jennifer Batisti3, Kishore Iyer1.
1Intestinal Rehabilitation & Transplantation Program, Mount Sinai Medical Center, New York, NY, United States; 2Gastroenterology, Concorde Medical Group, New York, NY, United States; 3Gastroenterology, Mount SInai West, New York, NY, United States
Background: Patients with intestinal failure (IF) from short bowel syndrome (SBS) typically require parenteral nutrition (PN) to meet caloric and hydration needs. Teduglutide (TED) is a glucagon-like peptide 2 (GLP-2) analog approved for treatment of adult SBS-IF. TED increases villus height and crypt depth in small bowel mucosa, promoting absorption and enteral independence from PN. There have been very few reports of TED use, beyond the multicenter trials that led to FDA approval. We report our single center experience with TED in adult patients with SBS. Primary end-point was autonomy from PN or intravenous fluids (IV). Secondary end-points included reduction in volume and number of days on PN/IV.
Method: Retrospective analysis of prospectively collected data on patients in a tertiary intestinal rehabilitation program (IRP) to identify patients with SBS treated with TED from 2009-2015. Between 2009 and 2011 patients were entered into a randomized, placebo-controlled multi-center trial ewported elsewhere. All patients entering the trial continued in a 2-year extension study and received open label drug. The current report includes all patients at our center who had ANY exposure to TED, including those on commercial drug after FDA.
Results: 18 patients were treated with TED. There were 11 females and 7 males, with a median age of 47 years (range 20-81). Ten patients (55 %) achieved complete enteral independence from PN/IV at a median of 8 months (3-36 months). PN/IV volume requirement was reduced in all patients except 2. Median weekly fluid volume reduction was 4.5 liters (0 L – 16.8 L). Fourteen patients (78%) were able to reduce PN/IV requirement by 1 or more days, including the 10 who achieved enteral autonomy from PN/IV. Nine of the 10 patients (90%) who achieved enteral autonomy had colon, with a median residual small bowel length of 50cm (15cm to 106 cm). All patients off PN/IV required additional oral vitamins & electrolytes. There were no significant side effects on TED requiring termination.
Conclusion: Our preliminary experience is consistent with prior reports of successful partial or complete weaning from PN/IV with TED treatment in adult patients with SBS. Presence of colon appears to be favorable in obtaining enteral independence from PN/IV, regardless of residual small bowel length. Patients on TED may remain at high risk of micronutrient deficiencies and require monitoring of micronutrient status and need for supplementation.
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