Off-label teduglutide therapy in non-intestinal failure patients with chronic malabsorption

Background: Teduglutide, a glucagon-like peptide 2 (GLP-2) analogue, has demonstrated efficacy in treating adult patients with short bowel syndrome (SBS) and dependence on parenteral nutrition (PN), but its role in chronic malabsorptive states that do not necessitate PN remains uncertain. Aims: To evaluate teduglutide use beyond its approved indications and to discuss the results of this adjunctive treatment in patients resistant to established therapy. Results: This series reports four patients treated with teduglutide off-label. The first case had Crohn’s Disease (CD) with persistent colocutaneous fistulae that demonstrated complete closure after eight months of teduglutide therapy. The second case involved a PN-dependent CD patient with persistent fistulae and intra-abdominal abscesses who weaned off PN and had a significant improvement in her nutritional status after three months of teduglutide therapy. The third case had CD complicated by severe malnutrition and previous PN-associated line infections, but by nine months of teduglutide therapy, she gained 5 kg and no longer required re-initiation of PN. The fourth case had a high-output diverting ileostomy with resultant impaired healing of a stage IV decubitus ulcer, and after two months of therapy, the patient’s pre-albumin increased by 250% and the ulcer had decreased by 40% in size. Conclusion: The use of teduglutide might be broadened to include patients with functional SBS not meeting strict criteria for intestinal failure. Further studies should evaluate the efficacy of teduglutide in patients who may require short-term small intestine rehabilitation or who have chronically impaired absorptive capacity not yet requiring PN.