Centre de Recherche du Centre Hospitalier de l'Université de Montréal Montreal, QC, Canada
Dane Christina Daoud, MD1, Katherine Schwenger, PhD2, Brian Jurevics, PharmD, MRes3, Scott Whittaker, MD, FRCPC4, Barbara Bielawska, MD, MSc, FRCPC5, David Armstrong, MA, MB BChir, FRCPC, FRCP(UK), FACG6, Donald R. Duerksen, MD7, Maitreyi Raman, MD, MSc, FRCPC8, James D. McHattie, MD, FRCPC9, Leah Gramlich, MD10, Johane P. Allard, MD, FRCPC2 1Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, PQ, Canada; 2University of Toronto, University Health Network, Toronto, ON, Canada; 3St. Michael's Hospital, Toronto, ON, Canada; 4University of British Columbia, Vancouver, BC, Canada; 5Ottawa Hospital, Ottawa, ON, Canada; 6McMaster University, Hamilton, ON, Canada; 7University of Manitoba, Winnipeg, MB, Canada; 8University of Calgary, Calgary, AB, Canada; 9University of Saskatchewan, Regina, SK, Canada; 10University of Alberta, Edmonton, AB, Canada
Introduction: Clinical trials have shown that teduglutide, a synthetic GLP-2 analog, reduces the need for parenteral support (PS) in adult patients with short bowel syndrome (SBS). The objective of this study was to assess, in routine clinical practice, the outcomes of SBS patients on PS enrolled in the Canadian home parenteral nutrition (HPN) registry.
Methods: This is a retrospective analysis of prospectively collected data extracted from the password protected, internet-based Canadian HPN registry. Adult SBS patients from 9 HPN programs, treated with teduglutide between January 2015 and 2021, were included. Data was collected every 6 months for 2 years and included demographics, anthropometrics, PS prescriptions, laboratories, hospitalizations, and quality of life based on the Karnofsky Performance Status (KPS). Response was defined as a daily PS volume reduction of ≥ 20% from baseline. Data was compared using Wilcoxon Rank Sum tests for continuous variables and Fisher’s exact tests for categorical variables.
Results: 32 patients [(19 (59%) women; age 57.6 ± 12.8 years)] were included, representing about 50% of patients receiving teduglutide in Canada. The main cause of SBS was Crohn’s disease (n=15, 47%); length of remaining small bowel was 79.5 ± 58.6 cm, and 14 patients (44%) had a colon in continuity. Over the study duration, 69% (n=23) were responders and 28% (n=9) achieved PS independency. Response at 18 months was associated with a longer PS duration before starting teduglutide (p=0.01), the absence of narcotics (p=0.01), a high oral intake (p=0.04), and Crohn’s disease (p=0.01). Patients who had been weaned had a longer PS duration (p=0.01), lower weekly infusion days at baseline (p=0.02) and lack of narcotics (0.01). Creatinine and electrolyte levels remained within normal limits in all patients. Alkaline phosphatase (ALP) levels were significantly lower in weaned patients compared to non-weaned after 6 (p=0.03) and 18 months (p=0.01) of treatment. BMI, KPS and number of hospitalizations per year at baseline were comparable between responders and non-responders and remained comparable over the 2-year period. No severe adverse events were reported.
Discussion: Teduglutide was effective in reducing or weaning PS in SBS adult patients similarly to clinical trials. Overall, there were no changes in laboratory results except for an improvement in ALP in weaned subjects. Hospitalization rate, KPS and BMI did not change with PS reductions and teduglutide was well tolerated.
Disclosures: Dane Christina Daoud: Takeda – Other Financial or Material Support, sponsorship for a fellowship in intestinal failure. Katherine Schwenger indicated no relevant financial relationships. Brian Jurevics indicated no relevant financial relationships. Scott Whittaker indicated no relevant financial relationships. Barbara Bielawska indicated no relevant financial relationships. David Armstrong: Takeda – Advisory Committee/Board Member, Consultant, Grant/Research Support. Donald R. Duerksen indicated no relevant financial relationships. Maitreyi Raman: Takeda – Grant/Research Support, Speaker's Bureau. James McHattie indicated no relevant financial relationships. Leah Gramlich indicated no relevant financial relationships. Johane Allard: takeda – Consultant, Speaker's Bureau.
Dane Christina Daoud, MD1, Katherine Schwenger, PhD2, Brian Jurevics, PharmD, MRes3, Scott Whittaker, MD, FRCPC4, Barbara Bielawska, MD, MSc, FRCPC5, David Armstrong, MA, MB BChir, FRCPC, FRCP(UK), FACG6, Donald R. Duerksen, MD7, Maitreyi Raman, MD, MSc, FRCPC8, James D. McHattie, MD, FRCPC9, Leah Gramlich, MD10, Johane P. Allard, MD, FRCPC2. P1958 - Clinical Outcomes of Adult Patients With Short Bowel Syndrome Treated With Teduglutide: A 2-year Cohort Study From the Canadian Home Parenteral Nutrition Registry, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.