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Teduglutide Enhances Structural Adaptation of the Small Intestinal Mucosa in Patients With Short Bowel Syndrome

Tappenden, Kelly A. PhD*; Edelman, Jeffrey MD; Joelsson, Bo MD

Journal of Clinical Gastroenterology: August 2013 - Volume 47 - Issue 7 - p 602–607
doi: 10.1097/MCG.0b013e3182828f57
ALIMENTARY TRACT: Original Articles

Background: Intestinotrophic therapies, such as glucagon-like peptide-2 (GLP-2) analogs, may enhance intestinal adaptation and reduce dependence on parenteral nutrition (PN) in patients with intestinal failure associated with short bowel syndrome (SBS-IF). However, because GLP-2 enhances cellular growth, there is concern that GLP-2 analogs may also encourage growth of malignant cells.

Aims: To histologically examine the effects of teduglutide, a recombinant human GLP-2 analog, on the mucosa of the small and large intestine for indications of dysplastic transformation.

Methods: In a multicenter, prospective, randomized, placebo-controlled study, 83 PN-dependent patients with SBS-IF were monitored for several weeks to ensure optimal and stable PN. Patients were then randomized to receive 24 weeks of placebo (n=16), teduglutide (0.5 mg/kg/d; n=35), or teduglutide (0.10 mg/kg/d; n=32).

Results: Biopsies were obtained from 77 patients to yield 390 individual histologic interpretations. After 6 months of treatment, no features of dysplasia were found in any biopsy from the large or small intestine of patients receiving placebo or either dose of teduglutide. New secondary diagnoses, such as eosinophilic colitis or Crohn’s disease, were found at a low frequency overall: teduglutide (0.05 mg/kg/d; range, 3.1% to 6.3%); teduglutide (0.10 mg/kg/d, 3.3%); placebo (range, 6.7% to 13.3%).

Conclusions: Although this histologic substudy of biopsy samples was not powered to detect differences in occurrence of dysplasia between teduglutide-treated patients and those randomized to placebo, it demonstrated that no dysplasia or other pathologic processes were evident within the intestinal mucosa in the placebo group or the 2 teduglutide groups after 6 months of treatment.

*Department of Nutrition and Gastrointestinal Physiology, University of Illinois at Urbana-Champaign, Champaign, IL

Department of Pathology, Christian Hospital, St Louis, MO

Department of Research & Development, NPS Pharmaceuticals, Inc., Bedminster, NJ

Supported by NPS Pharmaceuticals, Inc.

K.A.T. has served as a consultant for NPS Pharmaceuticals, Inc., B.J. is an employee of NPS Pharmaceuticals, Inc.

K.A.T., J.E., and B.J. contributed to study concept and design, study supervision, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content.

Reprints: Kelly A. Tappenden, PhD, Department of Nutrition and Gastrointestinal Physiology, University of Illinois at Urbana-Champaign, 443 Bevier Hall, 905 South Goodwin Avenue, Champaign, IL 61820. (e-mail: tappende@uiuc.ed).

Received July 12, 2012

Accepted December 11, 2012

© 2013 by Lippincott Williams & Wilkins