4CPS-003 Liraglutide in chronic intestinal failure: overview and case report

• Published in: European journal of hospital pharmacy. Science and practice Vol. 27; no. Suppl 1; pp. A48 - A49
• Main Authors: Scaldaferri, M, Castellana, E, Ippolito, M, Merlo, FD, Aimasso, U, De Francesco, A, Cattel, F
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.03.2020
• Subjects: Case reports; Ostomy; Peptides; Quality of life
• ISSN: 2047-9956; 2047-9964
• DOI: 10.1136/ejhpharm-2020-eahpconf.104

Background and importanceChronic intestinal failure (CIF) is a rare pathology, included in the 2013 Orphanet list. Parenteral nutrition is a lifesaving and often lifelong therapy because of nutrients loss and electrolyte and fluids imbalance related to impairment in intestinal absorption and high daily stoma output. Antimotility and antisecretory drugs can reduce faecal output and promote better nutrient and fluid absorption. An impaired hormonal ‘ileo-colonic brake’ may further worsen imbalance in patients with end jejunostomy short bowel syndrome (SBS-IF). Intestinal adaptation can occur in the remaining part of the bowel through secretion of gut trophic peptide hormones, such as glucagon-like peptide (GLP) 2 and 1. With large enteral resections, GLP secretion is virtually absent, and treatment with GLP analogues could be useful. Liraglutide is a GLP-1 analogue which reduces gastric hypersecretion and slows gastric emptying. In an open label, 8 week pilot study, liraglutide significantly reduced the ostomy wet weight output by 474±563 g/day (p=0.049).Aim and objectivesThe primary aim of the study was to evaluate the effect of liraglutide on faecal output in patients with SBS-IF and a high faecal output.Material and methodsData on faecal output, March 2018 to September 2019, were collected for patients with SBS-IF and a high faecal output, despite treatment with antimotility and antisecretory drugs, who received liraglutide to reduce ostomy output.ResultsTen patients received liraglutide at a standard dose. Small bowel length was <140 cm. Pretreatment faecal output was 3230 mL/day. Two patients did not respond to treatment, while the remaining eight patients (80%) achieved a post-treatment faecal output of 1983 mL/day, with an average reduction of 1402 mL/day (-43%) after 8 weeks of therapy. One patient discontinued therapy following intestinal recanalisation, while therapy is ongoing in seven patients. Liraglutide was well tolerated and all patients reported an improvement in quality of life.Conclusion and relevanceLiraglutide seems to have a place in the limited treatment armamentarium available for patients with SBS-IF, who have a significantly impaired quality of life.References and/or acknowledgements1. Hvistendahl M, et al. Effect of liraglutide treatment on jejunostomy output in patients with short bowel syndrome: an open-label pilot study. J Parenter Enteral Nutr 2018;42;112–121.No conflict of interest.