23: Teduglutide treatment in adult patients with short bowel syndrome: real-life use and long term outcomes

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Introduction: Short Bowel Syndrome (SBS) is a rare complex disease causing chronic intestinal failure (CIF) for which Parenteral Support (PS) is the reference treatment. Teduglutide (TED), a GLP-2 analogue, is available and reimbursed in France since 2015 for the treatment of SBS-CIF patients. The cost of this drug is very high and there is no data about the number of potential candidates in real life. The aim of the study was to analyze in a real-life setting the characteristics of SBS patients treated with TED over time, to evaluate the percentage of SBS-CIF patients treated with TED as well as the treatment outcomes since its market authorization. Methods: This work was a monocentric retrospective study conducted in an expert center of Home PS. We enrolled all patients with SBS-CIF followed in the center between 2015 and 2020. Two sub-populations were defined for this study: the prevalent population, composed of the patients who were already followed in the center before 2015, and the incident population, composed of the new patients who initiated follow-up in the center between 2025 and 2020. Populations were compared using Wilcoxon-mann-withney or pearson chi2 tests. TED retention rate was calculated using Kaplan-Meier survival estimate. Results: 331 patients were included in the study (156 prevalent and 175 incident patients). In total, 56 patients initiated a treatment with TED (16.9% of the cohort). 27.9% of prevalent patients initiated treatment, with an annual average rate of 4.3%, against 8.0% of incident patients, with an annual average rate of 2.5%. Treatment with TED allowed a median decrease of 60% (IQR 40-100) of PN volume in our cohort. The reduction of PN was significantly higher in the incident population than in the prevalent population (p=0.02). The long-term retention rate of treatment was 82% after 2 years, 67% after 3 years and 64% after 5 years. Among the non-treated patients, 50 patients (18.2%) were declared non suitable because of non-medical reasons (doubt about compliance, patient refusal, cognitive disorders…). Conclusion: In the prevalent population of SBS patients, more than a quarter of patients were treated with TED, with a progressive reduction of the number of newly treated patients each year, against 8% of incident population. These figures can be important to evaluate the number of potentially treated patients for centers starting to use TED. Furthermore, this real-life study reports a better response to TED in the incident population, suggesting a benefit of early treatment compared to late treatment. The treatment retention rate higher than 80% after two years, which can be explained by the careful selection of patients that is important to examine.

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