Imaging as predictor of clinical response to teduglutide in adult patients with short bowel syndrome with chronic intestinal failure.
Am J Clin Nutr
; 113(5): 1343-1350, 2021 05 08.
Article
em En
| MEDLINE
| ID: mdl-33675349
ABSTRACT
BACKGROUND:
Teduglutide (TED) is a glucagon-like peptide 2 analogue approved in patients with short bowel syndrome with chronic intestinal failure. Bowel epithelial hyperplasia has been reported after TED treatment.OBJECTIVE:
The aim of this study was to describe small bowel modifications at imaging in patients with SBS-CIF receiving TED and to assess their predictive value for clinical response.METHODS:
Monocentric retrospective study including patients with SBS-CIF treated with TED from 2009 to 2018 with available computed tomography (CT) scans at baseline and during follow-up (≥12 mo). Small bowel (SB) wall thickness was measured as the average of 3 measurements on different SB segments. Clinical response to TED was defined as a ≥20% reduction of weekly parenteral support (PS) volume at 12 mo.RESULTS:
Thirty-one patients [20 male (65%), median age 51 y (IQR 37-59)] were included. Baseline weekly PS volume was a median 7500 mL (IQR 3500-15,000). After a median (IQR) follow-up of 16 mo (14-27), 26 of 31 patients (84%) had a clinical response. During follow-up, patients underwent 1 (n = 18/31, 58%), 2 (10/31, 32%), or 3 (3/31 10%) CT scans. Median SB wall thickness was 4.0 mm (IQR 2.8-4.7) and 8.5 mm (IQR 6.1-9.8) at baseline and after treatment, respectively [paired P < 0.001, median +122% increase (IQR +65% to +172%)]. Patients with a clinical response had a trend toward a higher SB wall thickness increase [median +133% (IQR +70% to +176%) compared with +90% (IQR +52% to +93%), P = 0.061]. All patients with a ≥95% SB wall thickness increase (n = 18) had a clinical response, whereas only 8 of 13 (62%) patients with a <95% SB thickness increase did (P = 0.008).CONCLUSIONS:
Teduglutide induces a significant SB wall thickness increase that can be depicted by imaging <6 mo after treatment initiation, and the degree of such increase may be associated with clinical response. Bowel imaging in response to pharmacologic treatments may represent an important outcome to follow.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Peptídeos
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Síndrome do Intestino Curto
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Fármacos Gastrointestinais
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article