Thread by @valcohranmd

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma 2/ #MondayNightIBD #ShortBowelSyndrome #MedTwitter #GITwitter #MedPeds @BonumCe

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📸 Faculty disclosures & important CME info 👇

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma 3/#MondayNightIBD

💊💉Meds = important 🛠 in mgmt of #ShortBowelSyndrome

💎Antimotility & antisecretory agents frequently used to control stool loss
💎Incl loperamide, diphenoxylate w atropine, codeine, & tincture of opium
💎Most effective ~30 min B4 meals & @ bedtime 🛏

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma 4/Growth factors also available for #ShortBowelSyndrome
🚦Somatropin (rhGH) approved in SBS
🛑Use largely discontinued due to unacceptable toxicity & modest long-term efficacy

#MondayNightIBD

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma 5/#Teduglutide @US_FDA approved in 2012 for pts w SBS
💎Analog of GLP-2, peptide hormone secreted by L-cells
💎In intestinal lining, teduglutide ⬆️ villi height & depth between each villus
💎Leads to ⬆️ intestinal surface area for optimal nutrient absorption

#MondayNightIBD

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA 6/🪢By binding to GLP-2 receptors, teduglutide results in several actions w/in the intestines of pts w #ShortBowelSyndrome

⬇️Reduces gastric secretions
⬇️Slows movement of food
⬆️Increases Intestinal blood flow
#MondayNightIBD

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA 7/Teduglutide FDA indication:
✅Approved in adult & pediatric patients (≥1 year of age) w/ #ShortBowelSyndrome who are dependent on #ParenteralNutrition
✅Approval in adults based on STEPS trial

#MondayNightIBD

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA 8/ Phase 3 STEPS trial: double-blind, randomized study
📝Evaluated if teduglutide⬇️reduces #ParenteralNutrition requirement in adult pts w SBS-IF

📋Eligibility criteria
✓≥12m PN dependency
✓Requiring ≥3x weekly to meet caloric, fluid, or electrolyte needs

#MondayNightIBD

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale 9/STEPS trl: Pts achieving primary endpt of responder rate (>20%⬇️from BL in PN volume @ wks 20&24):
👉Respd rate:63% w teduglutide vs30% w PBO(P =0.002)
🚫significant impact by sml bowel length or colon continuity

greater magnitude change from BL in PN volume w TDG @ all f/u's

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd 10/ STEPS trial
🟰Incidence of AEs was similar w/ teduglutide vs placebo
🗒Most AEs were GI-related

#MondayNightIBD

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd @simongabe @OkeSiddhartha @jessicarauhmd @UFpedsurg @Paul_Wischmeyer @shannonchangmd @JessicaYAllen 11/ STEPS-2 open-label extension trial
In 65 pts 👉reductions in #ParenteralNutrition volumes translated to days off per wk 📆
#MondayNightIBD

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd @simongabe @OkeSiddhartha @jessicarauhmd @UFpedsurg @Paul_Wischmeyer @shannonchangmd @JessicaYAllen 12/Efficacy/safety of teduglutide in #pediatric pts w SBS-IF also demonstrated in a 24wk Ph3 trial

💎TDG assoc'd w significantly more ped pts achieving PE w no new safety signals

💎Both TDG dose groups also showed clin significant
⬇️PN volume
⬇️PN calories
⬇️ PN days/hrs req'd

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd @simongabe @OkeSiddhartha @jessicarauhmd @UFpedsurg @Paul_Wischmeyer @shannonchangmd @JessicaYAllen @BattatMD4IBD @LaurenCornellRD @Leicnut @johnmrosen 13/💉Teduglutide is administered SC
💉Can be self-administered in adults
📏Recommended dosage is 0.05 mg/kg once daily
📏Recommended dose adjustment to 0.025 mg/kg once daily in pts w mod/severe renal impairment

#MondayNightIBD

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd @simongabe @OkeSiddhartha @jessicarauhmd @UFpedsurg @Paul_Wischmeyer @shannonchangmd @JessicaYAllen @BattatMD4IBD @LaurenCornellRD @Leicnut @johnmrosen 14/⚠️Teduglutide Warning⚠️
⚠️Potential 4 neoplastic growth acceleration
🚫 Pts who develop GI maligncy🚫discontinue teduglutide
⚖️Pts who dvlp non-GI maligncy, clin decision of risk/benefit to continue teduglutide

#MondayNightIBD

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd @simongabe @OkeSiddhartha @jessicarauhmd @UFpedsurg @Paul_Wischmeyer @shannonchangmd @JessicaYAllen @BattatMD4IBD @LaurenCornellRD @Leicnut @johnmrosen 15/⚠️Teduglutide Warning⚠️
⬆️risk for neoplastic growth cont...
CLN recommendations
✅Adults: after 1yr of tx, then every 5yrs unless polyp is found
✅Children: annual FOBT; CLN/sigmoidoscopy after 1yr of tx, then every 5yrs or w any new/unexplained GI bleeding

#MondayNightIBD

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd @simongabe @OkeSiddhartha @jessicarauhmd @UFpedsurg @Paul_Wischmeyer @shannonchangmd @JessicaYAllen @BattatMD4IBD @LaurenCornellRD @Leicnut @johnmrosen 16/⚠️Teduglutide warning/precaution 4 biliary & pancreatic disease⚠️
⚠️Cholecystitis, cholangitis, cholelithiasis, & pancreatitis reported in trials
✅Obtain bilirubin, alk phosphatase, lipase, & amylase labs w/in 6m prior to tx, then @ least every 6m while on tx

#MondayNightIBD

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd @simongabe @OkeSiddhartha @jessicarauhmd @UFpedsurg @Paul_Wischmeyer @shannonchangmd @JessicaYAllen @BattatMD4IBD @LaurenCornellRD @Leicnut @johnmrosen 17/Thanks for joining me & #MondayNightIBD
🚀 Before you take off 🚀
Answer the post-polls below👇
🆓 #CME🔗bit.ly/3kmxQC5

#IBDPoll 1️⃣
Teduglutide, an FDA-approved tx for pts w SBS, works by binding to GLP-2 receptors to result in which of the following?

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd @simongabe @OkeSiddhartha @jessicarauhmd @UFpedsurg @Paul_Wischmeyer @shannonchangmd @JessicaYAllen @BattatMD4IBD @LaurenCornellRD @Leicnut @johnmrosen 18/#MondayNightIBD
#IBDPoll 2⃣

47yo/M w 2yr history of SBS (cancer-caused resection). At last f/u, frustrated due to impact of current PN routine on daily QoL; asks for way to reduce his PN dependency. Which is an appropriate response based on primary endpoint of STEPS trial?

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd @simongabe @OkeSiddhartha @jessicarauhmd @UFpedsurg @Paul_Wischmeyer @shannonchangmd @JessicaYAllen @BattatMD4IBD @LaurenCornellRD @Leicnut @johnmrosen 19/#MondayNightIBD
#IBDPoll 3⃣
🆓 #CME🔗bit.ly/3kmxQC5

In a pediatric trial, teduglutide (0.05 mg/kg) was associated with a ≥20% parenteral nutrition reduction at week 24 in what percentage of patients?

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd @simongabe @OkeSiddhartha @jessicarauhmd @UFpedsurg @Paul_Wischmeyer @shannonchangmd @JessicaYAllen @BattatMD4IBD @LaurenCornellRD @Leicnut @johnmrosen 20/#MondayNightIBD
#IBDPoll 4⃣
🆓 #CME🔗bit.ly/3kmxQC5

Teduglutide carries a warning/precaution regarding which of the following?

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd @simongabe @OkeSiddhartha @jessicarauhmd @UFpedsurg @Paul_Wischmeyer @shannonchangmd @JessicaYAllen @BattatMD4IBD @LaurenCornellRD @Leicnut @johnmrosen 21/#MondayNightIBD
#IBDPoll 5️⃣
🆓 #CME🔗bit.ly/3kmxQC5

Antimotility & antisecretory agents are best administered…

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd @simongabe @OkeSiddhartha @jessicarauhmd @UFpedsurg @Paul_Wischmeyer @shannonchangmd @JessicaYAllen @BattatMD4IBD @LaurenCornellRD @Leicnut @johnmrosen 22/#ICYMI #MondayNightIBD #ShortBowelSyndrome #MedTweetorial
💡 Focus: #ParenteralNutrition

https://twitter.com/MondayNightIBD/status/1579581166860275712

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd @simongabe @OkeSiddhartha @jessicarauhmd @UFpedsurg @Paul_Wischmeyer @shannonchangmd @JessicaYAllen @BattatMD4IBD @LaurenCornellRD @Leicnut @johnmrosen 23/#ICYMI #MondayNightIBD
💡 Focus: #CaseConvo re: adult patient w/ potential #ShortBowelSyndrome
w/ Drs. @DCharabaty & @Subramanian1MD

https://twitter.com/MondayNightIBD/status/1582116892134674433

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma @US_FDA @LiftEcho @franciscajoly @ChrisGastroDoc @dr_rdvenkatesh @JenniferLeeLee1 @temarahajjat @dr_bkaj @ashishpatelpch @ConradCole10 @jlightdale @LuriePedsRes @KevinWatsonJrMD @NU_MedEd @LuriePedFellows @IFFGD @UOAA @Subramanian1MD @DanielJDrucker @KendallBeckMD @guthealthmd @simongabe @OkeSiddhartha @jessicarauhmd @UFpedsurg @Paul_Wischmeyer @shannonchangmd @JessicaYAllen @BattatMD4IBD @LaurenCornellRD @Leicnut @johnmrosen 24/#ICYMI #MondayNightIBD #Webinar
💡 Focus: #MNIBDWebinar #pediatric patients w/ #ShortBowelSyndrome

https://twitter.com/MondayNightIBD/status/1569446068492062720