Imaging as predictor of clinical response to teduglutide in adult patients with short bowel syndrome with chronic intestinal failure

Abstract

Teduglutide (TED) is a glucagon-like peptide 2 analogue approved in patients with short bowel syndrome with chronic intestinal failure. Bowel epithelial hyperplasia has been reported after TED treatment. The aim of this study was to describe small bowel modifications at imaging in patients with SBS-CIF receiving TED and to assess their predictive value for clinical response. Monocentric retrospective study including patients with SBS-CIF treated with TED from 2009 to 2018 with available computed tomography (CT) scans at baseline and during follow-up (≥12 mo). Small bowel (SB) wall thickness was measured as the average of 3 measurements on different SB segments. Clinical response to TED was defined as a≥20% reduction of weekly parenteral support (PS) volume at 12 mo. Thirty-one patients [20 male (65%), median age 51 y (IQR: 37-59)] were included. Baseline weekly PS volume was a median 7500 mL (IQR: 3500-15,000). After a median (IQR) follow-up of 16 mo (14-27), 26 of 31 patients (84%) had a clinical response. During follow-up, patients underwent 1 (n=18/31, 58%), 2 (10/31, 32%), or 3 (3/31 10%) CT scans. Median SB wall thickness was 4.0 mm (IQR: 2.8-4.7) and 8.5 mm (IQR: 6.1-9.8) at baseline and after treatment, respectively [paired P<0.001, median+122% increase (IQR:+65% to +172%)]. Patients with a clinical response had a trend toward a higher SB wall thickness increase [median+133% (IQR:+70% to +176%) compared with +90% (IQR:+52% to +93%), P=0.061]. All patients with a≥95% SB wall thickness increase (n=18) had a clinical response, whereas only 8 of 13 (62%) patients with a<95% SB thickness increase did (P=0.008). Teduglutide induces a significant SB wall thickness increase that can be depicted by imaging<6 mo after treatment initiation, and the degree of such increase may be associated with clinical response.Bowel imaging in response to pharmacologic treatments may represent an important outcome to follow.