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Wang X, Chen H, Han S, Li L, Chen H, Yang B. The real-world analysis of adverse events with teduglutide: a pharmacovigilance study based on the FAERS database. Front Pharmacol 2024; 15:1404658. [PMID: 39329127 PMCID: PMC11424547 DOI: 10.3389/fphar.2024.1404658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 08/20/2024] [Indexed: 09/28/2024] Open
Abstract
Background Teduglutide, the first glucagon-like peptide 2 analogue, has been demonstrated to facilitate the absorption of gut nutrient and lessen the need for parenteral assistance in patients with Short Bowel Syndrome (SBS). However, its adverse drug events (AEs) are primarily documented in clinical trials, with a deficit in real-world data. This study evaluates the AEs profile of teduglutide based on Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) data. Method A disproportionality analysis of FAERS data from Quarter 1 (Q1) 2013 to Quarter 3 (Q3) 2023 was conducted to examine the association between teduglutide and adverse events, employing Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayesian Geometric Mean (EBGM) methods. Results Out of 13,809,302 reports in the FAERS database, 10,114 reports identified teduglutide as the "primary suspect" in AEs identification. During the dosing observation period, the median occurrence of adverse events was 393 days (interquartile range [IQR] 97-996 days). Teduglutide-associated AEs occurred in 27 System Organ Classes (SOC), of which renal and urinary disorders is not mentioned in the specification. Based on the four algorithms, a total of 260 major disproportionality preferred terms (PTs) were filtered out, including previously unreported AEs including weight decreased (n = 805), vascular device infection (n = 683), dehydration (n = 596) and nephrolithiasis (n = 146). Conclusion Our findings corroborate the AEs listed in the teduglutide prescribing information and additionally unveil new adverse reaction signals such as nephrolithiasis. These discoveries could aid in clinical monitoring and risk identification for teduglutide.
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Affiliation(s)
- Xiaogan Wang
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Inflammatory Bowel Disease Center/Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hao Chen
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Inflammatory Bowel Disease Center/Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shuangshuang Han
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Inflammatory Bowel Disease Center/Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Lingbo Li
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Inflammatory Bowel Disease Center/Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hongjin Chen
- Inflammatory Bowel Disease Center/Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Bolin Yang
- Inflammatory Bowel Disease Center/Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Abstract
OBJECTIVES The aim of the study was to describe the experience with teduglutide of several Spanish hospitals in pediatric patients with SBS (SBS). METHODS Seventeen pediatric patients with intestinal failure associated with SBS were treated with teduglutide. Patients received 0.05 mg · kg · day of subcutaneous teduglutide. Patients' demographics and changes in parenteral nutrition (PN) needs, fecal losses, and citrulline level initially and at 3, 6, and 12 months were collected, as well as any adverse events. RESULTS Patients were receiving 55 ml · kg · day and 33 kcal · kg · day of parenteral supplementation on average at baseline (2 patients received only hydroelectrolytic solution). A total of 12/17 patients achieved parenteral independence: 3 patients after 3 months of treatment, 4 patients at 6 months, and 5 after 12 months. One patient discontinued treatment 1 year after the beginning as no changes in parenteral support or fecal losses were obtained. All others decreased their intravenous requirements by 50%. One patient suffered an episode of cholecystitis, and another one with a pre-existing cardiac disease, developed a cardiac decompensation. CONCLUSIONS Teduglutide seems to be a safe and effective treatment in the pediatric SBS population with better results than in the pivotal study as well as in the adult population.
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Six-month outcomes of teduglutide treatment in adult patients with short bowel syndrome with chronic intestinal failure: A real-world French observational cohort study. Clin Nutr 2019; 39:2856-2862. [PMID: 31932048 DOI: 10.1016/j.clnu.2019.12.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/28/2019] [Accepted: 12/15/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Teduglutide, a GLP-2-analog, has proven effective in two placebo-controlled studies in reducing parenteral support (PS) in patients with short bowel syndrome-associated intestinal failure (SBS-IF) after 24 weeks. The aim of this study was to describe in a real-life situation the effects of teduglutide treatment and their predictive factors. METHODS We included 54 consecutive SBS-IF patients treated with teduglutide in France for at least 6 months from 10 expert centers. Small bowel length was 62 ± 6 cm and 65% had colon in continuity. PS was 4.4 ±0 .2 infusions per week, started 9.8 ± 1.2 years before. Response (PS reduction ≥ 20%) and PS discontinuation rates were assessed at week 24. Adjusted p values of factors associated with response and weaning were calculated using a multivariate logistic regression model. RESULTS At week 24, 85% of patients were responders and 24% had been weaned off PS, with a 51% reduction of PS needs and 1.5 ± 0.2 days off PS per week. Response to teduglutide was influenced by a higher baseline oral intake (p = 0.02). Weaning off PS was influenced by the presence of colon (p = 0.04), a lower PS volume (p = 0.03) and a higher oral intake (p = 0.01). There were no differences based on age, bowel length or SBS-IF causes. CONCLUSIONS Our study confirms the effectiveness of teduglutide in reducing PS needs in SBS-IF patients. We associated reduced parenteral support volume with baseline parenteral volume support, bowel anatomy, and oral intake. These findings underline the role of nutritional optimization when starting the treatment.
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Abstract
The ultimate goal of treatment of short bowel syndrome/intestinal failure patients is to achieve enteral autonomy by eliminating parenteral nutrition (PN)/intravenous fluids (IV). After optimization of diet, oral hydration and anti-diarrheal medications, attempt should be made to eliminate PN/IV. Weaning from PN/IV should be individualized for each patient. Although teduglutide is the preferred agent for PN/IV volume reduction or successful weaning, optimal patient selection and long-term safety need further evaluation. Following PN/IV elimination, patients need long-term monitoring for nutritional deficiencies. This article will address clinical considerations before, during, and after PN/IV weaning to facilitate safe and successful PN/IV weaning process.
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Affiliation(s)
- Andrew Ukleja
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center/Beth Israel Lahey Health, 330 Brookline Ave., Boston, MA 02215, USA.
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Pevny S, Maasberg S, Rieger A, Karber M, Blüthner E, Knappe-Drzikova B, Thurmann D, Büttner J, Weylandt KH, Wiedenmann B, Müller VA, Bläker H, Pascher A, Pape UF. Experience with teduglutide treatment for short bowel syndrome in clinical practice. Clin Nutr 2019; 38:1745-1755. [DOI: 10.1016/j.clnu.2018.07.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/10/2018] [Accepted: 07/27/2018] [Indexed: 12/20/2022]
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Kochar B, Herfarth HH. Teduglutide for the treatment of short bowel syndrome – a safety evaluation. Expert Opin Drug Saf 2018; 17:733-739. [DOI: 10.1080/14740338.2018.1483332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Bharati Kochar
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
- University of North Carolina Multidisciplinary Center for Inflammatory Bowel Diseases, Chapel Hill, NC, USA
| | - Hans H. Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
- University of North Carolina Multidisciplinary Center for Inflammatory Bowel Diseases, Chapel Hill, NC, USA
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Ukleja A, Alkhairi B, Bejarano P, Podugu A. De Novo Development of Hamartomatous Duodenal Polyps in a Patient With Short Bowel Syndrome During Teduglutide Therapy: A Case Report. JPEN J Parenter Enteral Nutr 2017; 42:658-660. [DOI: 10.1177/0148607117718480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/31/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Andrew Ukleja
- Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, USA
| | - Baker Alkhairi
- Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, USA
| | - Pablo Bejarano
- Department of Pathology, Cleveland Clinic Florida, Weston, Florida, USA
| | - Amareshwar Podugu
- Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, USA
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Billiauws L, Bataille J, Boehm V, Corcos O, Joly F. Teduglutide for treatment of adult patients with short bowel syndrome. Expert Opin Biol Ther 2017; 17:623-632. [DOI: 10.1080/14712598.2017.1304912] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Lore Billiauws
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support, APHP - University Paris VII, Clichy, France
| | - Julie Bataille
- Hopital Beaujon - Department of Pharmacy, APHP - University Paris VII, Clichy, France
| | - Vanessa Boehm
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support, APHP - University Paris VII, Clichy, France
| | - Olivier Corcos
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support, APHP - University Paris VII, Clichy, France
- Laboratory for Vascular Translational Science, UFR de Médecine Paris Diderot, Paris, France
| | - Francisca Joly
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support, APHP - University Paris VII, Clichy, France
- Centre de Recherche sur l’Inflammation, Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Paris, France
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Baldassano S, Amato A, Caldara GF, Mulè F. Glucagon-like peptide-2 treatment improves glucose dysmetabolism in mice fed a high-fat diet. Endocrine 2016; 54:648-656. [PMID: 26832341 DOI: 10.1007/s12020-016-0871-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/14/2016] [Indexed: 02/07/2023]
Abstract
Previous studies suggested that endogenous glucagon-like peptide 2 (GLP-2) is dispensable for the regulation of glucose homeostasis under normal conditions, while it can play a beneficial role in obesity conditions. The purpose of the present study was to investigate whether chronic treatment with Gly2-GLP-2, a stable analogue of GLP-2, can have an impact on glycaemic and lipid control in mice fed a high-fat diet (HFD), an animal model of human obesity and insulin resistance. HFD mice were treated once a day with Gly2-GLP-2 for 4 weeks. Body weight, food intake, fasting glucose, intraperitoneal glucose tolerance, insulin-induced glucose clearance, glucose-stimulated insulin secretion, β-cell mass, plasma lipid metabolic profile, and lipid deposition in the liver were examined. In untreated HFD mice, fasting glucose levels, glucose tolerance, glucose-stimulated plasma insulin and sensibility to exogenous insulin were deteriorating with time and β-cell mass increased. In Gly2-GLP-2-treated mice, we found significant increase in glucose tolerance and exogenous insulin sensitivity, reduction in glucose-stimulated plasma insulin and in the increase in β-cell mass in comparison with pair-aged HFD untreated animals. The chronic treatment with the peptide was not associated with remarkable improvements of dyslipidemia and it did not prevent liver fat accumulation and the presence of microvesicular steatosis. In conclusion, the results of the present study suggest, for the first time, that Gly2-GLP-2 may produce glucose metabolic benefits in mice with diet-induced obesity. The mechanisms underlying the beneficial impact of GLP-2 on glucose metabolism remain to be established.
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Affiliation(s)
- Sara Baldassano
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF), Laboratorio di Fisiologia generale, Università di Palermo, Viale delle Scienze, 90128, Palermo, Italy
| | - Antonella Amato
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF), Laboratorio di Fisiologia generale, Università di Palermo, Viale delle Scienze, 90128, Palermo, Italy
| | - Gaetano Felice Caldara
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF), Laboratorio di Fisiologia generale, Università di Palermo, Viale delle Scienze, 90128, Palermo, Italy
| | - Flavia Mulè
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF), Laboratorio di Fisiologia generale, Università di Palermo, Viale delle Scienze, 90128, Palermo, Italy.
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Abstract
PURPOSE OF REVIEW Intestinal failure because of more or less extensive resection of parts of the small and large intestine (short bowel syndrome) results from the reduction of absorptive surface of the remaining intestine and frequently results in dependence on parenteral nutrition. Parenteral nutrition, although lifesaving, is associated with short and long-term complications as well as with reduced quality of life and overall survival. RECENT FINDINGS Pharmacological enhancement of the physiological intestinal adaptive response by subcutaneous application of the glucagon-like peptide 2 analogue teduglutide results in an improved, hyperadaptive response. This is reflected by decreased parenteral calorie and fluid requirements, decreased parenteral nutrition infusion days per week including complete weaning off parenteral nutrition with complete oral autonomy, improved quality of life, and metabolic and nutritional stability. SUMMARY The advent of teduglutide as an authority-approved specific medication for intestinal failure in parenteral nutrition-dependent short bowel syndrome offers an effective and beneficial treatment for these patients. As a result, patients are more stable whether for medical or further surgical management including intestinal transplantation. Long-term efficacy and safety still have to be proven.
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Wiśniewski K, Sueiras-Diaz J, Jiang G, Galyean R, Lu M, Thompson D, Wang YC, Croston G, Posch A, Hargrove DM, Wiśniewska H, Laporte R, Dwyer JJ, Qi S, Srinivasan K, Hartwig J, Ferdyan N, Mares M, Kraus J, Alagarsamy S, Rivière PJM, Schteingart CD. Synthesis and Pharmacological Characterization of Novel Glucagon-like Peptide-2 (GLP-2) Analogues with Low Systemic Clearance. J Med Chem 2016; 59:3129-39. [DOI: 10.1021/acs.jmedchem.5b01909] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kazimierz Wiśniewski
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Javier Sueiras-Diaz
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Guangcheng Jiang
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Robert Galyean
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Mark Lu
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Dorain Thompson
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Yung-Chih Wang
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Glenn Croston
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Alexander Posch
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Diane M. Hargrove
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Halina Wiśniewska
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Régent Laporte
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - John J. Dwyer
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Steve Qi
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Karthik Srinivasan
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Jennifer Hartwig
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Nicky Ferdyan
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Monica Mares
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - John Kraus
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Sudarkodi Alagarsamy
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Pierre J. M. Rivière
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
| | - Claudio D. Schteingart
- Ferring
Research Institute Inc., 4245 Sorrento
Valley Boulevard, San Diego, California 92121, United States
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