Characterization of American teduglutide consumers from 2015 to 2020: A large database study

Abstract

Introduction: Teduglutide, a glucagon-like peptide-2 analog, is a novel therapy for intestinal failure that reduces need for parenteral support, especially in patients without a functional terminal ileum or colon. It can also predispose patients to accelerated progression of gastrointestinal (GI) malignancy and fluid overload. We demographically and clinically characterized American patients prescribed teduglutide. Methods:The Explorys database is an aggregate of deidentified patient data from dozens of US healthcare systems. We used SNOMED classification to identify patients prescribed teduglutide from 2015 to 2019. Through the browse cohort feature we determined the demographics, postsurgical anatomy, comorbidities, and indication for teduglutide use among these patients. Results:Of approximately 72 million patients, 170 were prescribed teduglutide. A large majority were female (70.6%). Most common etiologies of short-bowel syndrome were intestinal obstruction (52.9%) and Crohn's disease (41.2%). Common postsurgical anatomy included total colectomy (41.2%) and ileostomy. Common incident symptoms included abdominal pain (41.2%) and nausea (23.5%). Thirty (17.6%) patients were prescribed teduglutide despite comorbid heart failure, and 5.9% despite prior GI malignancy. A total of 11.8% of patients had a history of benign GI neoplasms before starting teduglutide. A total of 5.9% of patients had posttreatment formation of colon polyps. Conclusion:In a large American database, the teduglutide prescription is rare. Only a minority have postsurgical anatomy associated with the most robust response to teduglutide. Serious adverse events appear rare, but a substantial number of patients are at risk for adverse effects because of the presence of comorbid heart failure or GI neoplasm.

Epidemiology, survival, costs, and quality of life in adults with short bowel syndrome

“…Loutfy et al analyzed a commercial database to identify prescribed teduglutide from 2015 to 2019. 33 Of the 72 million patients in the database during the study period, 170 patients were prescribed teduglutide, the majority of whom had either Medicare (41.2%) or Medicaid (41.2%). As the indication for teduglutide is SBS and parenteral support dependency, most patients had a coded diagnosis of postsurgical malabsorption.…”

“…Loutfy et al analyzed a commercial database to identify prescribed teduglutide from 2015 to 2019 33 . Of the 72 million patients in the database during the study period, 170 patients were prescribed teduglutide, the majority of whom had either Medicare (41.2%) or Medicaid (41.2%).…”

Use of teduglutide in adults with short bowel syndrome–associated intestinal failure

“…54 Despite this recommendation, a retrospective analysis of a large population-based commercial database found that, between 2015 and 2019, 170 adult patients with SBS-IF were prescribed teduglutide, of whom 47% did not have a colonoscopy prior to initiating therapy. 55 As recent 13 : CIF requiring IVS with fluids and electrolytes alone is less severe than CIF requiring IVS of PN admixtures; the severity of CIF requiring IVS of PN progressively increases in parallel with the increase of the volume of the PN admixture, calculated on a weekly basis as the daily mean of the total volume infused per week (volume per day of infusion × number of infusions per week/7 [ml/day]): PN1 ≤1000, PN2=1001-2000, PN3=2001-3000, and PN4 >3000. b Perform tests with the patient's consent to define their eligibility for teduglutide treatment further. care reports showed the de novo development of upper GI adenomas in patients receiving teduglutide, gastroscopy before and during teduglutide treatment is advised.…”

“…Furthermore, it would allow for the detection and removal of polyps that may be at risk of progression following the initiation of teduglutide treatment 54 . Despite this recommendation, a retrospective analysis of a large population‐based commercial database found that, between 2015 and 2019, 170 adult patients with SBS‐IF were prescribed teduglutide, of whom 47% did not have a colonoscopy prior to initiating therapy 55 . As recent care reports showed the de novo development of upper GI adenomas in patients receiving teduglutide, gastroscopy before and during teduglutide treatment is advised 56,57 …”

Glucagon-like peptide-2 analogues for Crohn’s disease patients with short bowel syndrome and intestinal failure

“…Other documented adverse effects were abdominal pain (70 cases, 41.2%), nausea (40 cases, 23.5%), intestinal obstruction (30 cases, 17.6%) and stoma complications (20 cases, 11.8%). Ten patients (6%) developed colon polyps[ 73 ].…”