Abstract
Objectives
The glucagon-like peptide 2 (GLP-2) analog teduglutide (TED) is a novel therapy for intestinal failure that reduces need for parenteral support. Degree of response may correlate to location of surgical anastomoses. TED may worsen heart failure (HF) and gastrointestinal (GI) neoplasms. Using a large database we characterize American patients prescribed TED.
Methods
The Explorys national database (Cleveland, OH, USA) is an aggregate of de-identified patient data from 26 US healthcare systems. SNOMED classification was used to identify consecutive patients prescribed TED, 2015–2020. Demographics and comorbidities were collected. Preceding surgeries, suspected inciting conditions, and incident symptoms/events post TED were searched using the temporal attributes feature on Explorys.
Results
Of 72 million patients, 170 are prescribed TED. Age range of majority was 45–69 years. 70% were female, 82% caucasian and 12% African American. 70 used medicare, and 70 private insurance. In 50 patients, initial BMI was > 30, 40 had BMI < 19, and majority had BMI 19–29. 10 had opioid dependence, and 70 tobacco use. 30 started TED with comorbid HF; 10 had prior GI malignancy.
Common underlying conditions: bowel obstruction (N = 80), Crohn's (N = 70; 50 fistulizing, 10 abscess-forming), congenital gut malformation (N = 30), mesenteric ischemia (N = 30), and perforation (N = 20). <10 had radiation enteritis, traumatic intestinal injury and intestinal dysmotility.
Prior surgeries: 60 had ileostomy, and 40 colostomy. 90 had partial colonic resection and 30 partial excisions of small bowel. Only 10 had jejunal bypass, and <10 esophagojejunostomy, gastrojejunostomy, pancreaticojejunostomy, jejunojejunostomy, ileocolic anastomosis, and small bowel transplant.
Common incident symptoms/events: abdominal pain (N = 70), nausea (N = 40), intestinal obstruction (N = 30), stoma complications (N = 20), ≤10 had colon polyps, duodenal neoplasm, biliary disorder, pancreatitis, flatulence, and fluid overload.
Conclusions
In 26 US centers, TED use is rare and associated with several known indications for intestinal surgery. Most were not underweight, and many were obese at initiation. Serious adverse events appear rare. Increased awareness of TED is needed, but careful risk-benefit analysis is needed prior to prescribing TED in patients with GI neoplasms and HF.
Funding Sources
None.
Benign Duodenal Neoplasm