Teduglutide (Gattex): use, effects and side effects

In short bowel syndrome, teduglutide can help the intestine absorb more nutrients and fluid. This can lower the need for intravenous nutrition and fluids. In studies, some patients were able to stop this support entirely. 1 Because teduglutide promotes tissue growth, monitoring for intestinal polyps is also needed during treatment.

What is teduglutide?

Teduglutide is available under the brand name Gattex, and in some regions as Revestive. The drug is a modified form of the hormone glucagon-like peptide-2 (GLP-2). This hormone promotes the growth and repair of the intestinal lining.

The drug is used in short bowel syndrome, a condition in which a large part of the intestine is missing or does not work. As a result, the remaining intestine cannot absorb enough nutrients. People with the condition often need nutrition delivered through a vein, known medically as parenteral nutrition. Teduglutide was developed under the code name ALX-0600 and approved in the US in 2012.

How does teduglutide work?

Teduglutide binds to the GLP-2 receptor in the intestine, the docking site for the natural hormone. It acts for longer than the body’s own GLP-2: a single swapped amino acid makes it more resistant to the enzyme that breaks down natural GLP-2 within minutes.

When teduglutide activates the receptor, it stimulates growth of the intestinal lining. The villi get taller and the pits in the lining, called crypts, get deeper. This enlarges the surface through which the intestine can absorb nutrients and fluid.

In short bowel syndrome, this extra absorptive surface can help lower the need for intravenous support. In the pivotal study program and the extension study that followed, the large majority of people who kept using teduglutide were able to reduce their parenteral support. Some managed without it entirely. 1 This applies to those who continued treatment. Because teduglutide stimulates tissue growth, the colon also has to be checked for polyps.

Is teduglutide FDA-approved?

Yes. The US Food and Drug Administration (FDA) approved teduglutide in 2012 for adults with short bowel syndrome who need parenteral support. Approval for children aged 1 year and older followed later. The drug is injected under the skin once a day; this type of injection is called subcutaneous. 2

What is teduglutide prescribed for?

Teduglutide is prescribed for adults and children with short bowel syndrome who depend on parenteral nutrition or intravenous fluids. The aim of treatment is to reduce the need for this support.

Because teduglutide stimulates tissue growth, checks for intestinal polyps are planned before and during treatment. These include a colonoscopy. Which tests are needed before starting and at regular follow-ups also depends on age.

What side effects can occur?

The prescribing information lists the following side effects:

• Abdominal pain and a bloated abdomen
• Nausea and vomiting
• Upper respiratory tract infections
• Injection site reactions
• Fluid overload, in which too much fluid builds up in the body
• Allergic reactions

The more serious risks include:

• Growth of polyps in the colon and rectum, which is why colon checks are planned
• Intestinal obstruction
• Disorders of the gallbladder, bile ducts and pancreas
• Fluid overload