短肠综合征和慢性肠功能衰竭患者使用胰高血糖素样肽 2 类似物的实际经验：肠功能衰竭专家中心的国际调查结果。

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2024-11-01 DOI:10.1016/j.clnesp.2024.10.161

Tim Vanuytsel , Narisorn Lakananurak , Sophie Greif , Elizabeth Wall , Hilary Catron , Jean Herlitz , Lisa Moccia , Vanessa Kumpf , David Mercer , Mark Berner-Hansen , Leah Gramlich

{"title":"短肠综合征和慢性肠功能衰竭患者使用胰高血糖素样肽 2 类似物的实际经验：肠功能衰竭专家中心的国际调查结果。","authors":"Tim Vanuytsel , Narisorn Lakananurak , Sophie Greif , Elizabeth Wall , Hilary Catron , Jean Herlitz , Lisa Moccia , Vanessa Kumpf , David Mercer , Mark Berner-Hansen , Leah Gramlich","doi":"10.1016/j.clnesp.2024.10.161","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and aims</h3><div>Glucagon-like peptide 2 (GLP-2) analogues are the first available disease-modifying treatments for patients with intestinal failure (IF) due to short bowel syndrome (SBS). Efficacy in terms of reduction of parenteral support (PS) has been demonstrated in multiple studies and real-world reports. However, it remains unclear how many patients are eligible to receive the treatment, when treatment is started after intestinal resection, how treatment efficacy is assessed outside of clinical trials, and how the treatment is modified in case of non-response or adverse events. The aim of this study was to investigate the real-world management of patients treated with GLP-2 analogues in expert centers around the world.</div></div><div><h3>Methods</h3><div>A survey questionnaire was developed by a multidisciplinary working group consisting of 52 questions related to various aspects of multidisciplinary care of SBS-IF patients. The 17 questions related to the use of GLP-2 analogues in clinical practice were analyzed for this study. The online survey was sent to 33 participating centers in a phase 3 study of a long-acting GLP-2 analogue. Only responses from countries with access to commercially available GLP-2 analogues were included in the study. A descriptive analysis was performed for each question. Results are presented as median (interquartile range).</div></div><div><h3>Results</h3><div>The responses from the 19 expert IF centers with access to GLP-2 analogues indicated that 10 (10–20) % of patients with SBS-IF were treated with a GLP-2 analogue, which was less than the number of eligible patients (30 (25–40) %). In most centers (10 centers, 53 %), GLP-2 therapy was started 6–12 months after the last intestinal resection, with 5 centers (26 %) starting later (12–24 months). Multiple parameters were used in combination to determine the response to GLP-2 analogues of which the three most common were >20 % decrease in PS (95 %), at least 1 day of PS reduction per week (84 %) and increased urinary output (68 %). In non-responders GLP-2 therapy was stopped within the first year by 67 % of the centers. Finally, strategies in case of significant adverse events include stopping the GLP-2 analogue (used by 79 % of experts), dose reduction (67 %) and temporary treatment interruption (62 %).</div></div><div><h3>Conclusion</h3><div>The results of this survey completed by expert IF centers show the real-life use of GLP-2 analogues in clinical practice. Key learning points identified include the accounting for a period of intestinal adaptation before starting GLP-2 analogues and not stopping the treatment too early in case of non-response. The best strategy in case of adverse effects should be studied further.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 496-502"},"PeriodicalIF":2.9000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Real-world experience with glucagon-like peptide 2 analogues in patients with short bowel syndrome and chronic intestinal failure: Results from an international survey in expert intestinal failure centers\",\"authors\":\"Tim Vanuytsel , Narisorn Lakananurak , Sophie Greif , Elizabeth Wall , Hilary Catron , Jean Herlitz , Lisa Moccia , Vanessa Kumpf , David Mercer , Mark Berner-Hansen , Leah Gramlich\",\"doi\":\"10.1016/j.clnesp.2024.10.161\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background and aims</h3><div>Glucagon-like peptide 2 (GLP-2) analogues are the first available disease-modifying treatments for patients with intestinal failure (IF) due to short bowel syndrome (SBS). Efficacy in terms of reduction of parenteral support (PS) has been demonstrated in multiple studies and real-world reports. However, it remains unclear how many patients are eligible to receive the treatment, when treatment is started after intestinal resection, how treatment efficacy is assessed outside of clinical trials, and how the treatment is modified in case of non-response or adverse events. The aim of this study was to investigate the real-world management of patients treated with GLP-2 analogues in expert centers around the world.</div></div><div><h3>Methods</h3><div>A survey questionnaire was developed by a multidisciplinary working group consisting of 52 questions related to various aspects of multidisciplinary care of SBS-IF patients. The 17 questions related to the use of GLP-2 analogues in clinical practice were analyzed for this study. The online survey was sent to 33 participating centers in a phase 3 study of a long-acting GLP-2 analogue. Only responses from countries with access to commercially available GLP-2 analogues were included in the study. A descriptive analysis was performed for each question. Results are presented as median (interquartile range).</div></div><div><h3>Results</h3><div>The responses from the 19 expert IF centers with access to GLP-2 analogues indicated that 10 (10–20) % of patients with SBS-IF were treated with a GLP-2 analogue, which was less than the number of eligible patients (30 (25–40) %). In most centers (10 centers, 53 %), GLP-2 therapy was started 6–12 months after the last intestinal resection, with 5 centers (26 %) starting later (12–24 months). Multiple parameters were used in combination to determine the response to GLP-2 analogues of which the three most common were >20 % decrease in PS (95 %), at least 1 day of PS reduction per week (84 %) and increased urinary output (68 %). In non-responders GLP-2 therapy was stopped within the first year by 67 % of the centers. Finally, strategies in case of significant adverse events include stopping the GLP-2 analogue (used by 79 % of experts), dose reduction (67 %) and temporary treatment interruption (62 %).</div></div><div><h3>Conclusion</h3><div>The results of this survey completed by expert IF centers show the real-life use of GLP-2 analogues in clinical practice. Key learning points identified include the accounting for a period of intestinal adaptation before starting GLP-2 analogues and not stopping the treatment too early in case of non-response. The best strategy in case of adverse effects should be studied further.</div></div>\",\"PeriodicalId\":10352,\"journal\":{\"name\":\"Clinical nutrition ESPEN\",\"volume\":\"64 \",\"pages\":\"Pages 496-502\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical nutrition ESPEN\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2405457724014992\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"NUTRITION & DIETETICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical nutrition ESPEN","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2405457724014992","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}

引用次数: 0

摘要

背景和目的：胰高血糖素样肽 2（GLP-2）类似物是短肠综合征（SBS）所致肠功能衰竭（IF）患者的第一种可用疾病调节疗法。多项研究和实际报告都证实了其在减少肠外支持（PS）方面的疗效。然而，目前仍不清楚有多少患者符合接受治疗的条件、肠切除术后何时开始治疗、在临床试验之外如何评估疗效以及在出现无应答或不良反应时如何调整治疗方法。本研究旨在调查世界各地专家中心对接受 GLP-2 类似物治疗的患者的实际管理情况：方法：一个多学科工作组编制了一份调查问卷，其中包括 52 个问题，涉及 SBS-IF 患者多学科治疗的各个方面。本研究分析了与临床实践中使用 GLP-2 类似物相关的 17 个问题。在线调查发送给了长效 GLP-2 类似物 3 期研究的 33 个参与中心。只有能够获得市售 GLP-2 类似物的国家的回复才被纳入研究范围。对每个问题都进行了描述性分析。结果以中位数（四分位数间距）表示：结果：19 个可使用 GLP-2 类似物的 IF 专家中心的答复显示，10（10-20）% 的 SBS-IF 患者接受了 GLP-2 类似物治疗，少于符合条件的患者人数（30（25-40）%）。在大多数中心（10 个中心，53%），GLP-2 治疗是在最后一次肠切除术后 6-12 个月开始的，5 个中心（26%）开始时间较晚（12-24 个月）。在确定对 GLP-2 类似物的反应时，会综合使用多个参数，其中最常见的三个参数是 PS 下降 >20%（95%）、每周 PS 至少下降一天（84%）和尿量增加（68%）。对于无应答者，67%的中心在第一年内停止了 GLP-2 治疗。最后，出现重大不良事件时的应对策略包括停止使用 GLP-2 类似物（79% 的专家使用）、减少剂量（67%）和暂时中断治疗（62%）：由 IF 中心专家完成的这项调查结果显示了 GLP-2 类似物在临床实践中的实际使用情况。总结出的主要学习要点包括：在开始使用 GLP-2 类似物之前，应考虑到肠道的适应期；在出现无应答的情况下，不要过早停止治疗。出现不良反应时的最佳策略有待进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Real-world experience with glucagon-like peptide 2 analogues in patients with short bowel syndrome and chronic intestinal failure: Results from an international survey in expert intestinal failure centers

Background and aims

Glucagon-like peptide 2 (GLP-2) analogues are the first available disease-modifying treatments for patients with intestinal failure (IF) due to short bowel syndrome (SBS). Efficacy in terms of reduction of parenteral support (PS) has been demonstrated in multiple studies and real-world reports. However, it remains unclear how many patients are eligible to receive the treatment, when treatment is started after intestinal resection, how treatment efficacy is assessed outside of clinical trials, and how the treatment is modified in case of non-response or adverse events. The aim of this study was to investigate the real-world management of patients treated with GLP-2 analogues in expert centers around the world.

Methods

A survey questionnaire was developed by a multidisciplinary working group consisting of 52 questions related to various aspects of multidisciplinary care of SBS-IF patients. The 17 questions related to the use of GLP-2 analogues in clinical practice were analyzed for this study. The online survey was sent to 33 participating centers in a phase 3 study of a long-acting GLP-2 analogue. Only responses from countries with access to commercially available GLP-2 analogues were included in the study. A descriptive analysis was performed for each question. Results are presented as median (interquartile range).

Results

The responses from the 19 expert IF centers with access to GLP-2 analogues indicated that 10 (10–20) % of patients with SBS-IF were treated with a GLP-2 analogue, which was less than the number of eligible patients (30 (25–40) %). In most centers (10 centers, 53 %), GLP-2 therapy was started 6–12 months after the last intestinal resection, with 5 centers (26 %) starting later (12–24 months). Multiple parameters were used in combination to determine the response to GLP-2 analogues of which the three most common were >20 % decrease in PS (95 %), at least 1 day of PS reduction per week (84 %) and increased urinary output (68 %). In non-responders GLP-2 therapy was stopped within the first year by 67 % of the centers. Finally, strategies in case of significant adverse events include stopping the GLP-2 analogue (used by 79 % of experts), dose reduction (67 %) and temporary treatment interruption (62 %).

Conclusion

The results of this survey completed by expert IF centers show the real-life use of GLP-2 analogues in clinical practice. Key learning points identified include the accounting for a period of intestinal adaptation before starting GLP-2 analogues and not stopping the treatment too early in case of non-response. The best strategy in case of adverse effects should be studied further.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.