Introduction Prior to the availability of teduglutide (TED), functional bowel length was recognised as an important prognostic factor in patients (pts) with short bowel syndrome (SBS).1 Pts with shorter residual small bowel following intestinal resection generally are more likely to remain chronically dependent on parenteral support (PS) to meet fluid and nutrient needs.1TED enhanced absorption and reduced the PS volume needed to maintain clinical status in a wide range of pts with varying etiologies and durations of SBS.2-4 In the STEPS (NCT00798967) study, 27/43 (63%) TED-treated vs 13/43 (30%) placebo-treated pts achieved responder criteria (≥20% reduction in weekly PS volume from baseline at Wks 20 and 24).4 Mean PS volume reduced by 4.4 L/wk at Wk 24 from the baseline mean volume of 12.9 L/wk. This subanalysis was undertaken to determine the impact of TED in pts with ultra-short (≤40 cm) remnant bowel and/or no colon-in-continuity.
Methods Data from pts randomised to TED 0.05 mg/kg/day in STEPS whose bowel length was known (n = 40) were assessed by descriptive statistics. Also, data from all pts randomised to TED 0.05 mg/kg/day in STEPS, regardless of bowel length (n = 43), were analysed according to presence or absence of colon-in-continuity. No between-group comparisons were done owing to the small sample size.
Results Responder criteria were met by similar percentages of pts regardless of bowel length, including pts with remnant bowel length ≤25 or ≤40 cm (Table). At Wk 24, pts in each of these 2 groups with ultra-short bowel had mean decreases in weekly PS volume of 3.9 and 3.6 L, respectively. Data analysis from all pts randomised to TED, regardless of bowel length, found that 13/17 (77%) pts without colon-in-continuity and 14/26 (54%) pts with colon-in-continuity met the responder criteria. Furthermore, the mean change in weekly PS volume at Wk 24 was greater for pts with no colon-in-continuity (–6.4 L/wk) than pts with colon-in-continuity (–3.2 L/wk).
Conclusion Pts without colon-in-continuity show a numerically greater response to TED, perhaps reflecting natural adaptation by GLP-2 secreting cells in pts with colon-in-continuity. The overall findings reinforce the benefits of treatment with TED 0.05 mg/kg/day to enhance absorptive capacity in SBS regardless of remnant anatomy.
References 1 O’Keefe, et al. Clin Gastroenterol Hepatol 2006;4:6–10.
2 Jeppesen, et al. Gut 2005;54:1224–31.
3 Jeppesen, et al. Gut 2011;60:902–14.
4 Jeppesen, et al. Gastroenterology 2012;143:1473–81.
Disclosure of Interest None Declared
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