The assessment of the effectiveness and safety of teduglutide in the treatment of children with chronic intestinal insufficiency. A systematic review

Abstract

Chronic intestinal failure is a pathogenetic component in children with short bowel syndrome. Short bowel syndrome limits the patient's capacity to socialize fully, the bad prognosis of the child's physical and spiritual development, and the patient's family's organizational and material issues. The severity of the problem is aggravated by the limited prospects for surgical treatment of patients, including transplantology, the imperfection of the legal framework for health care, particularly in terms of parenteral nutrition at home, and the supply of expensive drugs, consumables, and equipment to children with short bowel syndrome under state guarantees. Developing an equivalent of glucagon-like peptide-2 (GLP-2), a drug teduglutide representing the endogenous intestinal growth factor and intestinal adaptation, created an additional therapeutic possibility for individuals with short bowel syndrome. There are no data in Russian academic literature on the efficacy and safety of teduglutide in pediatric practice. This study aims to conduct a systematic search and critical analysis of publications on the effectiveness and safety of using teduglutide in children with short bowel syndrome. Publications from the PubMed, Scopus, and eLibrary databases, as well as scientific journals, were examined from 2012 to 2022. The articles were reviewed in English and Russian. Seven hundred seventy publications on using teduglutide in experimental and clinical practice were found; 94 sources matched the keywords; and eight articles were selected according to the PRISMA criteria. The risks of confounding bias were assessed using the ROBINS-I tool. Most patients received the therapeutic impact of teduglutide, and 8.4%64.7% of patients achieved enteral autonomy. The drug's dose was 0.05 mg/kg/day. Without a therapeutic effect, the time limits for the inappropriate use of teduglutide ranged from 6 months to 1 yr. There is no causal relationship between taking teduglutide and undesirable reactions to treatment. The review of publications revealed an insufficient evidence foundation for the efficacy of teduglutide due to a lack of control groups in most studies, a small sample size, and errors in data methodology. Despite the encouraging preliminary results of individual studies, the problem of a shortage of randomized controlled tests of teduglutide remains.