Efficacy of Teduglutide for Parenteral Support Reduction in Patients with Short Bowel Syndrome: A Systematic Review and Meta-Analysis

Abstract

Teduglutide has been described as an effective treatment for parenteral support (PS) reduction in patients with short bowel syndrome (SBS). However, a quantitative summary of the available evidence is still lacking. PubMed/Medline, EMBASE, Cochrane library, OVID, and CINAHL databases were systematically searched up to July 2021 for studies reporting the rate of response (defined as a ≥20% reduction in PS) to teduglutide among PS-dependent adult patients. The rate of weaning (defined as the achievement of PS independence) was also evaluated as a secondary end-point. Ten studies were finally considered in the meta-analysis. Pooled data show a response rate of 64% at 6 months, 77% at 1 year and, 82% at ≥2 years; on the other hand, the weaning rate could be estimated as 11% at 6 months, 17% at 1 year, and 21% at ≥2 years. The presence of colon in continuity reduced the response rate (-17%, 95%CI: (-31%, -3%)), but was associated with a higher weaning rate (+16%, 95%CI: (+6%, +25%)). SBS etiology, on the contrary, was not found to be a significant predictor of these outcomes, although a nonsignificant trend towards both higher response rates (+9%, 95%CI: (-8%, +27%)) and higher weaning rates (+7%, 95%CI: (-14%, +28%)) could be observed in patients with Crohn's disease. This was the first meta-analysis that specifically assessed the efficacy of teduglutide in adult patients with SBS. Our results provide pooled estimates of response and weaning rates over time and identify intestinal anatomy as a significant predictor of these outcomes.

Keywords: chronic intestinal failure; parenteral nutrition; parenteral support; short bowel syndrome; teduglutide.

Figure 1

Flow-chart of study inclusion. Abbreviations: PS, parenteral support.

Figure 2

Forest plot for the estimation of the response rate at 6 months, 1 year, and ≥2 years. Abbreviations: CI, confidence interval.

Figure 3

Forest plot for the estimation of the differences in the response rates over time, evaluated in studies reporting these data in the same patient cohort at different time points (1 year vs. 6 months (A); ≥2 years vs. 6 months (B); ≥2 years vs. 1 year (C)). Abbreviations: CI, confidence interval; Diff., difference; Resp., responders; Non resp., nonresponders; vs., versus.

Figure 4

Forest plot for the estimation of the weaning rate at 6 months, 1 year, and ≥2 years. Abbreviations: CI, confidence interval.

Figure 5

Forest plot for the estimation of the differences in the weaning rate over time, evaluated in studies reporting these data in the same patient cohort at different time points (1 year vs. 6 months (A); ≥2 years vs. 6 months (B); ≥2 years vs. 1 year (C)). Abbreviations: CI, confidence interval; Diff., difference; vs., versus.

Figure 6

Forest plot comparing the response rate (A) and the weaning rate (B) according to the presence or the absence of colon in continuity. Reported results did not account for dropouts due to insufficient data. In the study by O’Keefe et al., only the data concerning patients treated with the 0.05 mg/kg/day dosing schedule could be extracted. Abbreviations: CI, confidence interval; Diff., difference; Resp., responders; Non resp., non responders.

Figure 7

Forest plot comparing the response rate (A) and the weaning rate (B) according to SBS etiology. Reported results do not account for dropouts due to insufficient data. In the study by O’Keefe et al., only the data concerning patients treated with the 0.05 mg/kg/day dosing schedule could be extracted. Abbreviations: CI, confidence interval; Diff., difference; Resp., responders; Non resp., nonresponders.