AIM: Glucagon-like peptide-2 analogues are part of the treatment algorithm for chronic intestinal failure to improve enteral nutrient absorption and reduce reliance on parenteral support. The purpose of this review is to update, consolidate and comprehensively evaluate the existing body of evidence, highlighting the breadth of positive clinical outcomes associated with glucagon-like peptide-2 analogue treatment.
METHODS: A systematic review was conducted using OVID Medline, Embase, Cochrane Library, CINAHL, and Web of Science. Studies reporting on glucagon-like peptide-2 analogue use in adults focusing on any change in clinical outcomes were included, while studies reporting solely biochemical outcomes were excluded. Meta-analyses and meta-regressions were conducted using R software. Where insufficient data was present, results were pooled and weighted by sample size or presented as a narrative synthesis.
RESULTS: 23 studies were included in the final review and analysis. Teduglutide demonstrated a positive and incremental effect on the proportion of short bowel syndrome-associated intestinal failure patients achieving a ≥20 % reduction in PS requirements, with response rates increasing from 64 % (95 % CI: 51 %-75 %) at 6 months to 73 % (95 % CI: 65 %-80 %) after ≥2 years of therapy. A similar trend was observed in patients achieving enteral autonomy, which rose from 13 % (95 % CI: 6 %-25 %) at 6 months to 31 % (95 % CI: 23 %-40 %) after ≥2 years of treatment. Moreover, early data shows teduglutide to have a positive effect on quality of life and stool characteristics of patients. Teduglutide appears to be an acceptable therapy, with a discontinuation rate of 14 %. Early reports suggest similar benefits for emerging GLP-2 including glepaglutide and apraglutide.
