Experiencia con el uso de teduglutide en pacientes pediátricos con fallo intestinal en un centro de Argentina

Abstract

Introduction. Teduglutide is a synthetic analogue of the glucagon-like peptide type 2, recently approved in Europe and in the United States for paediatric use, to promote intestinal adaptation in short bowel syndrome cases. The experience in children is limited. Objective. The aim of this work is to present the evolution of the first paediatric series treated with teduglutide in Argentina. Material and methods. A prospective study was realized on patient records under 18 years treated in a rehabilitation and intestine transplant unit since 2017. Of 62 children with short bowel syndrome, 5 received teduglutide 0.05 mg/kg/subcutaneous day. Diagnostics, type of anatomy and evolution of parenteral nutrition requirements were realized . Results. Etiology of short bowel syndrome: 3 congenital malformations: 2 atresias, 1 gastroschisis, two causes in older children: 1 volvulus and 1 abdominal trauma. Anatomy. Three patients type 2A, one type 2B and one type 3A, the length of the remaining intestine (mean and DS) 25.7 ± 19 cm, 1 with ileocecal valve and colon, 4 left hemicolon. The age at the beginning of parenteral nutrition was 6.2 ± 0.4 years, time on previous parenteral nutrition was 7.1 ± 4 years. The treatment time with teduglutide was 52.2 ± 39 weeks. The parenteral nutrition requirements were reduced by 56 ± 48%, in all patients, and could be suspended in 2 (at the 29th and 24th weeks of treatment). There was no deterioration of the z score of BMI/age (initial 0.16 ± 0.3 vs. 0.14 ± 1.02), nor of the height/age (-2.01 ± 1.5 vs. -1.76 ± 1.42). Conclusion. It was concluded that the use of teduglutide as a therapeutic alternative in the short bowel syndrome in paediatrics was effective and safe in this group of patients, allowing the restoration of intestinal sufficiency or reducing the requirements of parenteral nutrition.