Maintenance of Parenteral Nutrition Volume Reduction,Without Weight Loss,After Stopping Teduglutide in a Subset of Patients With Short Bowel Syndrome

Abstract

Background: Teduglutide was discontinued after being tested for ≥ 24 weeks in patients with parenteral nutrition (PN) -dependent short bowel syndrome in a clinical trial for efficacy to reduce PN volume. This study was describes change in body mass index (BMI) and PN volume over 12 months in patients who stopped drug after the clinical trial. Methods: Prescribed PN volume, weight, and complications were reported. Patients with stable (NEUT, n = 15) or decreased (DEC, n = 7) PN volume by 12 months after stopping drug (NEUT/DEC, n = 22) were compared to those who had increased PN volume (INC, n = 15). With drug response defined by ≥20% reduction from pre-drug PN volume to end of drug therapy, 12 INC and 13 NEUT/DEC patients were drug responders. Results: Eleven of 20 eligible sites reported data for 39 of 53 eligible study participants, with follow-up data for 37. INC patients had shorter colon and less frequently had colon in continuity than NEUT/DEC. BMI was decreased at 3, 6, and 12 months relative to the first off-drug visit in INC patients (P = .001), but not in NEUT/DEC patients. Change in BMI off-drug was predicted by colon and small bowel length, baseline BMI, and on-drug change in PN volume (adjusted R2 = 0.708). Conclusions: Gastrointestinal anatomy, baseline BMI, and PN volume reduction on-drug predicted change in BMI off-drug. Whether this response would be maintained for a longer time or in the context of a challenging clinical situation has not been evaluated.

Keywords

short bowel syndrome glucagon-like peptide 2 teduglutide parenteral nutrition intestinal failure

Get full access to this article

View all access options for this article.

References

Chan

McCowen

Bistrian

. Incidence, prognosis, and etiology of end-stage liver disease in patients receiving home total parenteral nutrition. Surgery. 1999;126(1):28-34.

Cavicchi

Beau

Crenn

Degott

Messing

. Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure. Ann Intern Med. 2000;132(7):525-532.

Salvino

Ghanta

Seidner

Mascha

Steiger

. Liver failure is uncommon in adults receiving long-term parenteral nutrition. JPEN Parenter Enteral Nutr. 2006;30:202-208.

Pironi

Joly

Forbes

. Long-term follow-up on patients on home parenteral nutrition in Europe: implications for intestinal transplantation. Gut. 2011;60:17-25.

Haderslev

Tjellesen

Haderslev

Staun

. Assessment of the longitudinal changes in bone mineral density in patients receiving home parenteral nutrition. JPEN J Parenter Enteral Nutr. 2004;28(5):289-294.

Buchman

. Complications of long-term home total parenteral nutrition: their identification, prevention and treatment. Dig Dis Sci. 2001;46(1):1-18.

O’Keefe

Buchman

Fishbein

Jeejeebhoy

Jeppesen

Shaffer

. Short bowel syndrome and intestinal failure: consensus definitions and overview. Clin Gastroenterol Hepatol. 2006;4:6-10.

Hyltander

Bosaeus

Svedlund

. Supportive nutrition on recovery of metabolism, nutritional state, health-related quality of life, and exercise capacity after major surgery: a randomized study. Clin Gastroenterol Hepatol. 2005;3(5):466-474.

Jeppesen

Gilroy

Pertkiewicz

Allard

Messing

O’Keefe

. A randomized placebo-controlled clinical trial of teduglutide in reducing parenteral nutrition infusions in short bowel syndrome patients. Gut. 2011 Feb 11. doi:10.1136/gut.2010.218271.

10.

DiBaise

Matarese

Messing

Steiger

. Strategies for parenteral nutrition weaning in adult patients with short bowel syndrome. J Clin Gastroenterol. 2006;40:S94-S99.

11.

Messing

Crenn

Beau

Boutron-Ruault

Rambaud

Matuchansky

. Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome. Gastroenterology. 1999;117(5):1043-1050.

12.

Crenn

Coudray-Lucas

Thuillier

Cynober

Messing

. Postabsorptive plasma citrulline concentration is a marker of absorptive enterocyte mass and intestinal failure in humans. Gastroenterology. 2000;119:1496-1505.

13.

Jeppesen

Hartmann

Thulesen

. Glucagon-like peptide 2 improves nutrient absorption and nutritional status in short-bowel patients with no colon. Gastroenterology. 2001;120:806-815.

14.

Jeppesen

Sanguinetti

Buchman

. Teduglutide (ALX-0600), a dipeptidyl peptidase IV resistant glucagon-like peptide 2 analogue, improves intestinal function in short bowel syndrome patients. Gut. 2005;54:1224-1231.

15.

Jeppesen

Lund

Gottschalck

. Short bowel patients treated for two years with glucagon-like peptide 2: effects on intestinal morphology and absorption, renal function, bone and body composition, and muscle function. Gastroenterol Res Pract. 2009;2009. doi:10.1155/2009/616054.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.21 MB