Optimizing teduglutide treatment regimens in children with short bowel syndrome

Short bowel syndrome (SBS) is the main cause of intestinal failure (IF) in children, leading to severe malabsorption and dependence on parenteral nutrition (PN). The glucagon-like peptide-2(GLP-2) analogue teduglutide (TED) has emerged as the disease-specific treatment strategy capable of stimulating intestinal adaptation to promote PN reduction. In recent years, new randomized pediatric trials and growing real-world experience show that TED enables complete enteral autonomy in up to 30% of patients. This rate is much higher than the 16% reported in a 2022 systematic review of 14 pediatric studies, indicating that new research have generated different findings that can help optimize TED treatment regimens. These findings suggest that children with SBS who have significant baseline differences in PN dependence (lower PN volume, lower PN dependency index [PNDI], and fewer infusions per week) can benefit the most from teduglutide treatment. Determining the optimal timing to initiate TED for children with SBS requires individualized strategies rather than a universal recommendation. In addition, long-term administration of TED(at least one year before reassessing treatment response) is required in the treatment of SBS-IF to achieve the best therapeutic effect, which is essential for optimizing TED treatment regimens in children.