The Journal of Parenteral and Enteral Nutrition recently published clinical considerations and best-practice recommendations for introducing Gattex ® (teduglutide [rDNA origin]) for injection into the management of short bowel syndrome (SBS). The recommendations conclude that integrating Gattex into a coordinated approach to treating SBS may result in more success in rehabilitating the intestine and weaning from parenteral nutrition (PN)/intravenous (IV) fluids in these patients.
Gattex is indicated for the treatment of adults with SBS who are dependent on parenteral support. Full prescribing information for Gattex is available at www.Gattex.com. The complete guidelines can be viewed at the Journal of Parenteral and Enteral Nutrition website by searching “teduglutide.”
The goal of intestinal rehabilitation is to enhance nutrient processing and absorptive capacity of the remaining gastrointestinal tract, allowing for maximum oral intake of nutrients and fluids. Until recently, the approaches for achieving this goal have been limited to dietary intervention, antidiarrheal and antisecretory medications, and surgical bowel reconstruction. The article considers the integration of Gattex, a targeted agent, in conjunction with best-practice recommendations, including strategies for PN/IV weaning and the importance of an integrated approach centering on specialized care.
“Teduglutide achieves intestinal adaptation as evidenced by significant reductions in PN/IV dependence or even complete weaning of this supportive care in some patients with short bowel syndrome,” said Douglas L. Seidner, MD, director of Vanderbilt Center for Human Nutrition at Vanderbilt Medical Center in Nashville and lead author. “Due to the complexities of short bowel syndrome and the need for individualized management strategies, patients should be referred to major centers with experience in short bowel syndrome, particularly during the early stages of teduglutide treatment.”Prior to initiating therapy with Gattex, the authors suggest optimizing fluids, electrolytes, nutrients, and adjunctive medications. They also recommend establishing baseline parameters for monitoring purposes, particularly nutrient balance and liver function for those requiring long-term, home use of parenteral nutrition, or HPN. Pre-planning and communication between the various healthcare providers and the patient are strongly recommended to allow for a well-coordinated care plan. Further, the authors recommend that patients be referred to major centers with experience in intestinal rehabilitation and that Gattex prescribers adhere to the warnings and requirements for the specific population of patients described in the product’s label.