1: Impact of food intake on the efficacy of Teduglutide treatment in adult patients with short bowel syndrome

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Introduction: Teduglutide (TED), a GLP-2 agonist, is effective to reduce Parenteral Nutrition (PN) dependence in patients with Short Bowel Syndrome (SBS), with some heterogeneity of response between patients. PN reduction at 6 months of TED treatment is significantly associated with patients’ oral intake at baseline (1). We aimed to study the impact of food intake on TED efficacy in the longer term and the evolution of food intake during treatment. Methods: This work was a monocentric retrospective study conducted in an expert center of PN. We enrolled 49 SBS patients treated with TED for at least one year. Information regarding oral food intake and PN prescription at the time of initiation and during treatment were collected in medical charts. Food intake is expressed using a ratio: FIR = Daily caloric intake (kcal)/ Resting Energy Expenditure (REE) (kcal). REE is calculated using Harris and Benedict formula. Results: Baseline food intake at treatment initiation was collected for 49 patients, and at least two values of food intake during treatment were available for 44 of these patients. The mean follow-up duration of the patients is 27 months (±2.8). There is a positive correlation between food intake at treatment initiation and reduction of PN volume during treatment (r=0.38, p=0.007). Moreover, patients who reached PN weaning with TED (n=19) had a much higher food intake before TED than those who remained dependent to PN (n=30), p<0.001 (FIR=2.3 vs 1.6). These 19 weaned patients were all hyperphagic (FIR>1.5) before TED initiation. In addition, patients who had the lowest food intake before TED initiation (non-hyperphagic, FIR<1.5, n=13) significantly increased their oral intake during treatment (p=0.001, FIR=1.0 vs 1.6). Those who presented hyperphagia before TED maintained their oral intake. Conclusion: This study confirms the positive impact of basal oral dietary intake on the efficacy of TED in the long term, which supports the idea of promoting food intake in SBS patients before TED initiation. Furthermore, treatment with TED seems to have a beneficial effect on patients’ food intake when it was low before TED initiation, which could be linked with the better physical and/or psychological condition of the patients. (1) Joly F et al. 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. 2020 Sep;39(9):2856-2862. doi: 10.1016/j.clnu.2019.12.019.

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