The Polish Intestinal Failure Centres' consensus on the use of teduglutide for the treatment of short bowel syndrome

Abstract

Objective: Teduglutide is an active, glucagon-like peptide (GLP)-2 analog with proven clinical efficacy regarding intestinal adaptation in patients with short bowel syndrome (SBS). There are two factors that preclude its reimbursement, and thereby, its availability: its cost (reaching ∼$300,000/y)-which significantly exceeds the cost of home parenteral nutrition (HPN) in most countries-and the lack of clear guidelines. The aim of this study was to create evidence-based working criteria for the use of teduglutide that could be used in clinical settings.

Methods: Experts from the Polish Network of Intestinal Failure Centers analyzed available research and considered experience on the topic of HPN and intestinal failure to create guidelines.

Results: Experts agreed that there are two groups of HPN patients who can benefit from therapy with a GLP-2 analog: those with a good prognosis (in whom complete weaning from HPN may be possible) and those with a poor prognosis (the therapy would be lifesaving). Patient criteria comprise the following: inclusion and exclusion criteria, parameters that can be used for monitoring, outcome measures, and the rationale for the termination of the treatment.

Conclusions: It was possible to describe inclusion criteria for both patient groups that justify the use of teduglutide from medical and economic perspectives.

Keywords: GLP-2; Liver failure; Short bowel syndrome.