Teduglutide in Patients With Active Crohn’s Disease and Short Bowel Syndrome
Notice bibliographique
Résumé
To the Editors: Short bowel syndrome (SBS) is a malabsorptive disorder often necessitating parenteral nutrition (PN) support to maintain electrolyte, fluid, and nutritional homeostasis.1,2 Patients with refractory Crohn’s disease (CD) are at high risk for SBS as a result of repeated surgical resections or extensive luminal inflammation that reduces absorptive capacity.3 The risk of chronic intestinal failure requiring PN in patients with CD has remained stable despite the introduction of biologic therapies, highlighting a need for improved therapeutic options.4 Teduglutide is a glucagon-like peptide (GLP)-2 analogue that is approved for the treatment of patients with PN-dependent SBS.5 However, there may be hesitancy to use teduglutide in patients with active CD because of theoretical concerns that its intestinotrophic actions may exacerbate inflammation. Here, we present 2 cases of patients with active CD and SBS treated with combination teduglutide and biologic therapy with no disease flare. The first case is a 38-year-old male with ileocolic, stricturing CD, previously failing immunosuppressants, infliximab, and adalimumab. He underwent multiple surgeries resulting in SBS and daily PN in 2011. Teduglutide was commenced in 2017, and he completely weaned off PN within 7 months. Recurrence of CD at the ileocolic anastomosis was treated with ustekinumab, and both treatments have since been maintained for 15 months without any adverse events. The second case is a 39-year-old male with steroid-dependent stricturing small bowel CD, previously failing immunosuppressants, infliximab, and adalimumab. After multiple resections, he was left with a jejunocolic anastomosis and 60 cm of residual small bowel length. Daily PN was initiated in 2003. He was initiated on vedolizumab and 6-mercaptopurine in 2016, and teduglutide was added in 2017, with significant improvement in oral intake, reduced stool output, and weight gain. His PN requirements reduced to 1 night per week, and he has been maintained on combination therapy without any adverse events. Patients with CD were initially excluded from phase III randomized controlled trials evaluating teduglutide efficacy and safety6,7 because of a perceived risk of exacerbating mucosal inflammation. However, the management of patients with PN-dependent CD with SBS is especially challenging because most will continue to have active inflammation that compromises the functional absorptive capacity of residual small bowel. Treatment strategies that optimize both inflammatory control and nutritional status are required. Here, we present 2 patients with CD and SBS safely treated with combination biologic and teduglutide, allowing control of intestinal inflammation and substantial reductions in PN support. Patient consent: Informed consent has been obtained from all patients. Version: April 1, 2019.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,006 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».