Postsurgical Intestinal Rehabilitation Using Semisynthetic Glucagon-Like Peptide-2 Analogue (sGLP-2) at a Referral Center: Can Patients Achieve Parenteral Nutrition and sGLP-2 Independency?
glp2
home nutrition support
intestinal failure
parenteral nutrition
rehabilitation
short bowel syndrome
surgery
teduglutide
Journal
JPEN. Journal of parenteral and enteral nutrition
ISSN: 1941-2444
Titre abrégé: JPEN J Parenter Enteral Nutr
Pays: United States
ID NLM: 7804134
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
28
05
2020
accepted:
27
07
2020
pubmed:
3
8
2020
medline:
3
11
2021
entrez:
3
8
2020
Statut:
ppublish
Résumé
Teduglutide, a semisynthetic analogue of glucagon-like peptide-2 (sGLP-2), increases intestinal absorption of fluids and nutrients, reducing the need for parenteral nutrition (PN). This report aims to describe our experience with sGLP-2 in a cohort of adult patients with short-bowel syndrome. This is a prospective observational study on adult patients initially evaluated in our specialized intestinal rehabilitation program that received sGLP-2 from June 2014 to March 2020. Autologous gastrointestinal reconstruction surgery (AGIRS) was performed in 108 patients; 68.5% (74 of 108) achieved intestinal sufficiency with standard medical therapy. Seventeen patients were treated with sGLP-2; 66.5% (8 of 12) received treatment for a mean time of 25.8 weeks (3.4-54.0) and could suspend PN. One patient reinitiated treatment due to renal lithiasis and acute renal failure. Currently, 7 of 12 patients (53.8%) continue without PN for a mean time of 165.6 weeks. Volume, energy, and days of PN were reduced in all patients. No serious adverse events were registered. Four of 7 patients (57.1%) who discontinued PN could also discontinue sGLP-2. Therefore, the use of sGLP-2 increased the overall success rate of PN independency after AGIRS to 76% (82 of 108). This study confirmed that sGLP-2 should be considered as part of the standard therapy for postsurgical medical rehabilitation treatment in patients with chronic intestinal failure. We add to the current knowledge that some patients can discontinue both PN and sGLP-2 in the long term, achieving complete recovery of their quality of life.
Sections du résumé
BACKGROUND
Teduglutide, a semisynthetic analogue of glucagon-like peptide-2 (sGLP-2), increases intestinal absorption of fluids and nutrients, reducing the need for parenteral nutrition (PN). This report aims to describe our experience with sGLP-2 in a cohort of adult patients with short-bowel syndrome.
METHODS
This is a prospective observational study on adult patients initially evaluated in our specialized intestinal rehabilitation program that received sGLP-2 from June 2014 to March 2020.
RESULTS
Autologous gastrointestinal reconstruction surgery (AGIRS) was performed in 108 patients; 68.5% (74 of 108) achieved intestinal sufficiency with standard medical therapy. Seventeen patients were treated with sGLP-2; 66.5% (8 of 12) received treatment for a mean time of 25.8 weeks (3.4-54.0) and could suspend PN. One patient reinitiated treatment due to renal lithiasis and acute renal failure. Currently, 7 of 12 patients (53.8%) continue without PN for a mean time of 165.6 weeks. Volume, energy, and days of PN were reduced in all patients. No serious adverse events were registered. Four of 7 patients (57.1%) who discontinued PN could also discontinue sGLP-2. Therefore, the use of sGLP-2 increased the overall success rate of PN independency after AGIRS to 76% (82 of 108).
CONCLUSION
This study confirmed that sGLP-2 should be considered as part of the standard therapy for postsurgical medical rehabilitation treatment in patients with chronic intestinal failure. We add to the current knowledge that some patients can discontinue both PN and sGLP-2 in the long term, achieving complete recovery of their quality of life.
Substances chimiques
Gastrointestinal Agents
0
Glucagon-Like Peptide 2
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1072-1082Informations de copyright
© 2020 American Society for Parenteral and Enteral Nutrition.
Références
Pironi L, Arends J, Baxter J, et al. ESPEN endorsed recommendations. Definition and classification or intestinal failure in adults. Clin Nutr 2015;34(2):171-180.
Pironi L. Definitions of intestinal failure and the short bowel syndrome. Best Pract Res Clin Gastroenterol 2016;30(2):173-185
Pironi L. Revised ESPEN clinical classification of chronic intestinal failure: from 16 to 8 categories. JPEN J Parenter Enteral Nutr. 2017;41(6):911-911.
Messing B, Crenn, P, Beau P, Boutron-Ruault MC, Rambaud JC, Matuchansky C. Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome. Gastroenterology. 1999;117(5):1043-1050.
Amiot A, Messing B, Corcos O, Panis Y, Joly F. Determinants of home parenteral nutrition dependence and survival of 268 patients with non-malignant short bowel syndrome. Clin Nutr. 2013;32(3):368-374.
Pironi L, Arends J, Bozzetti F, et al. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr. 2016;35(2):247-307.
Messing B, Joly F. Guidelines for management of home parenteral support in adult chronic intestinal failure patients. Gastroenterology. 2006;130(2):S43-S51.
Pironi L, Goulet O, Buchman A, et al. Outcome on home parenteral nutrition for benign intestinal failure: a review of the literature and benchmarking with the European prospective survey of ESPEN. Clin Nutr. 2012;31(6):831-845.
Lal S, Pironi L, Wanten G, et al. Clinical approach to the management of intestinal failure associated liver disease (IFALD) in adults: a position paper from the home artificial nutrition and chronic intestinal failure special interest group of ESPEN. Clin Nutr. 2018;37(6):1794-1797.
Mitra A, Ahn J. Liver disease in patients on total parenteral nutrition. Clin Liver Dis. 2017;21(4):687-695.
Joly F, Baxter J, Staun M, et al. Five-year survival and causes of death in patients on home parenteral nutrition for severe chronic and benign intestinal failure. Clin Nutr. 2018; 37(4):1415-1422.
Sudan D, Rege A. Update on surgical therapies for intestinal failure. Curr Opin Organ Transplant. 2014;19(3):267-275.
Gondolesi G, Pattin F, Nikkoupur H. Management of intestinal failure in middle-income countries, for children and adults. Curr Opin Organ Transplant. 2018;23(2):212-218.
Gondolesi GE, Doeyo M, Echevarria C, et al. Results of surgical and medical rehabilitation for adult patients with type iii intestinal failure in a comprehensive unit today: building a new model to predict parenteral nutrition independency. JPEN J Parenter Enteral Nutr. 2020;44(4):703-713.
Abu-Elmagd KM, Armanyous SR, Fujiki M, et al. Management of five hundred patients with gut failure at a single center: surgical innovation versus transplantation with a novel predictive model. Ann Surg. 2019;270(4):656-674.
Kelly DG, Tappenden KA, Winkler MF. Short bowel syndrome: highlights of patients management, quality of life, and survival. JPEN J Parenter Enteral Nutr. 2014;38(4):427-437.
Fishbein TM, Gondolesi GE, Kaufman SS. Intestinal transplantation for gut failure. Gastroenterology. 2003;124(6):1615-1628.
Abu-Elmagd K. The concept of gut rehabilitation and the future of visceral transplantation. Nat Rev Gastroenterol Hepatol. 2015;12(2):10-20.
Kaufman SS, Avitzur Y, Beath SV, et al. New Insights into the indications for intestinal transplantation: consensus in the year 2019. Transplantation. 2019;104(5):937-946.
Gondolesi GE, Doeyo M, SolarMuñiz H. A detailed analysis of the current status of intestinal transplantation in Latin America. Curr Opin Organ Transplant. 2020;25(2):189-195.
Drucker DJ, Erluch P, Asa SL, Brubaker PL. Induction of intestinal epithelial proliferation by glucagon-like peptide 2. Proc Natl Acad Sci. 1996;93(15):7911-7916.
Wojdemann M, Wettergen A, Hartmann B, Holst JJ. Glucagon like peptide-2 inhibits centrally induce antral motility in pigs. Scand J Gastroenterol. 1998;33(8):828-832.
Wojdemann M, Wettergen A, Hartmann B, Hilsted L, Holst JJ. Inhibition of sham feeding stimulated human gastric acid secretion by glucagon-like peptide 2. J Clin Endocrinol Metab. 1999;84(7):2513-2517.
Byrne TA, Wilmore D, Iyer K, et al. Growth hormone, glutamine, and an optimal reduces parenteral nutrition in patients with short bowel syndrome. Ann Surg. 2005;242(5):655-661.
Messing B, Blethen S, Dibaise J, Matarese L, Steiger E. Treatment of adult short bowel syndrome with recombinant human growth hormone. A review of clinical studies. J Clin Gastroenterol. 2006;40(1):s75-s84.
Wales PW, Nasr A, de Silva N, Yamada J. Human growth hormone and glutamine for patients with short bowel syndrome (review). Cochrane Libr. 2010;(6):CD006321.
Martin GR, Beck PL, Sigalet DL. Gut hormones and short bowel syndrome: the enigmatic role of glucagon like peptide 2 in the regulation of intestinal adaptation. World of Gastroenterol. 2006;12(26):4117.
Bremhold L, Hornum M, Henrisken BM, Larsen S, Holst JJ. Glucagon-like peptide 2 increases mesenteric blood flow in humans. Scand J Gastroenterol. 2009;44(3):314-319.
Jeppesen PB, Gilroy R, Pertkiewicz M, Allard JP, Messing B, O´Keefe SJ. 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):902-914.
Jeppesen PB. Teduglutide a novel glucagon like peptide 2 analog in the treatment of patients with short bowel syndrome. Therap Adv Gastroenterol. 2012;5(3):159-171.
Jeppesen PB, Pertkiewicz M, Messing B, et al. Teduglutide reduces need for parenteral support among patients with short bowel syndrome with intestinal failure. Gastroenterology. 2012;143(6):1473-1481.
Schwartz LK, O´Keefe SJD, Fujioka K, et al. Long-Term Teduglutide for the treatment of patients with intestinal failure associated with short bowel syndrome. Clin Transl Gastroenterol. 2016;7(2):e142.
Seidner DL, Fujioka K, Boullata JI, Iyer K, Lee HM, Ziegler TR. 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.
O´Keefe SJ, Jeppesen PB, Gilroy R, Pertkiewicz M, Allard JP, Messing B. Safety and efficacy on Teduglutide after 52 weeks of treatment in patients with short bowel intestinal failure. Clin Gastroenterol Hepatol. 2013;11(7):815-823.
Iyer KR, Kunecki M, Boullata JI, et al. Independence from parenteral nutrition and intravenous fluid support during treatment with Teduglutide among patients with intestinal failure associated with short bowel syndrome. JPEN J Parenter Enter Nutr. 2017;41(6):946-951.
Lam K, Schwartz L, Batisti J, Iyer KR. Single center experience with the use of teduglutide in adult patients with short bowel syndrome. J Parenter Enter Nutr. 2018;42(1):225-230.
Jeppesen PB, Gabe SM, Seidner DL, Lee HM, Olivier C. Factors associated with response to teduglutide in patients with short bowel syndrome and intestinal failure. Gastroenterology. 2018;154(4):874-885.
Compher C, Gilroy R, Pertkiewicz M, et al. Maintenance of parenteral nutrition volume reduction without weight loss, after stopping teduglutide in a subset of patients with short bowel syndrome. JPEN J Parenter Enteral Nutr 2011;35(5):603-609.
Pevny S, Maasberg S, Rieger A, et al. Experience with teduglutide for short bowel syndrome in clinical practice. Clin Nutr. 2019;38(4):1745-1755.
Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920-924.
Elsabbagh AM, Hawksworth J, Khan KM, et al. Long-term survival in visceral transplant recipients in the new era: a single-center experience. Am J Transplant. 2019;19(7):2077-2091.
Raghu VK, Binion DG, Smith KJ. Cost-effectiveness of teduglutide in adult patients with short bowel syndrome: Markov modeling using traditional cost-effectiveness criteria. Am J Clin Nutr. 2020;111(1):141-148.
Gondolesi G, Ramisch D, Padin J, et al. What is the normal small bowel length in humans? First donor-based cohort analysis. Am J Transplant. 2012;12(Suppl 4):S49-S54.