Emerging drugs for the treatment of short bowel syndrome

ABSTRACT

Introduction

SBS is a rare and disabling condition. The standard management is based on diet optimization with parenteral supplementation. In addition, glucagon-like peptide-2 (GLP-2)analogs, have shown promising results as disease-modifying therapies for SBS.

Areas Covered

Short bowel syndrome (SBS) is defined as a reduction in functional intestinal length to less than 200 cm, leading to intestinal failure (IF) leading to malnutrition and parenteral support dependency. This review discusses the current management of SBS-CIFpatients, the place of GLP-2 analog treatment in terms of efficacy, safety and availability, and the new perspectives opened by the use of enterohormones.

Expert Opinion

Clinical trials and real-world experience demonstrated that Teduglutide   reduces dependence on parenteral support and has a place in the management of patients with SBS-CIF.  The use of Teduglutide should be discussed in patients stabilized after resection and its introduction requires the advice of an expert center capable of assessing the benefit-risk ratio. The complex, individualized management of SBS-C IF requires theexpertise of a specialized IF center which a multidisciplinary approach. The arrival of new treatments will call for new therapeutic strategies, and the question of how to introduce and monitor them will represent a new therapeutic challenge.

KEYWORDS:

• Short bowel syndrome
• teduglutide
• GLP-2 analogs
• glepaglutide
• apraglutide
• liraglutide
• GLP-1 analogs
• entero-hormones

Article highlights

• Short bowel syndrome is a severe and complex condition requiring a complex and multimodal management. Most of the patient requiring long term parenteral nutrition to maintain growth and health leading to severe complication.

• GLP2 analogues, in particular Teduglutide have demonstrated their value in the management of short small bowel syndrome by considerably reducing the need for parenteral support.

• At present, new enterohormones such as long-half-life GLP2 analogues and GLP1 analogues are under investigation and look promising for the management of short-small bowel syndrome.

• The limitations of their use remain their high cost and side effects, particularly in the case of digestive neoplasms.

• Our expert opinion suggests that hormone enteropathies have their place in patient management, but that their use requires the advice of an expert center to enable personalized, multidisciplinary patient management.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.