R. Gunnar et al. J Pediatr Gastroenterol Nutr. 2026;83:37–45. Outcomes and adverse effects of teduglutide treatment with periodic withdrawal in pediatric short bowel patients

Methods: In this retrospective registry-based nationwide study from Finland, all pediatric short bowel–associated intestinal failure (IF) patients (n=20) who were treated with teduglutide were reviewed. Median follow-up was 31 months.

Key findings:

The Good:

• In the 19 who received treatment for 6 months, the median reductions in daily parenteral support (PS) energy and fluid volume requirement were 42% and 28 mL/kg/day, respectively.
• Weekly infusion-free nights increased from 0.5 to 4.
• Six patients (32%) successfully weaned off PS (while on teduglutide). Three patients who weaned off PS were subsequently able to come off teduglutide. Their pretreatment PS energy provision ranged from 19% to 33%, and all retained some colon (30%–100%). All of these patients who were able to stop teduglutide had received treatment for a minimum of 23 months.

The Bad:

• Four patients (20%) experienced intestinal bleeding while on teduglutide. This occurred on average 5 months (range: 3–8) after treatment initiation.
• Stomal prolapses occurred in all patients with end-jejunostomies.
• Patients in our study had endoscopies performed every 12–24 months, and none had mucosal neoplastic lesions. However, inflammatory changes were common.
• Periodic withdrawal (n = 37) led to adverse effects on 84% of occasions (n = 32). Serious adverse effects included unplanned hospitalizations (n=2), dehydration in 19 (51%), and diarrhea in 28 (76%) occasions. There was also suspected D-lactic acidosis, significant electrolyte or blood glucose disturbances, and weight loss. One patient was treated in the intensive care unit due to severe electrolyte disturbances. To mitigate these adverse effects, their clinicians increased intravenous fluid volume or parenteral energy during 15 withdrawal periods. Another 15 periods were terminated prematurely due to deteriorating clinical condition, including weight loss (n = 4), dehydration (n = 9), acidosis (n = 8), diarrhea (n = 3), or combinations of these.

Discussion:

• “Mandatory drug-free withdrawal periods due to the national reimbursement policy caused frequent adverse effects.” Finnish policy requires yearly 4-week teduglutide-free periods to renew reimbursement. “Hospital visits took place in 38% of the withdrawal periods, and two children were hospitalized.”
• “SBS patients with remaining colon have better chances of weaning off PS…The patients who weaned off both teduglutide and PS had low PS energy requirements at the start of the study and may have been able to wean off even without the medication.”

My take: For most SBS patients, I would not recommend teduglutide. This study shows the frequent adverse consequences during the study period; more adverse effects are possible years later, which is why endoscopic surveillance is recommended in those who have received teduglutide. In addition, there is a high risk of severe adverse effects if the medication is stopped, whether planned or unplanned. In addition to the downsides apparent in this study, the authors neglect to explore the financial costs of teduglutide therapy, including the indirect costs related to endoscopic monitoring and complications.

Related blog posts:

• Teduglutide Study on Parenteral Nutrition – It Does NOT Reduce Costs
• Teduglutide-Induced Polyps
• Dr. Danielle Wendel: Management of Short Bowel Syndrome
• Dr. Valeria Cohran: Short Bowel Syndrome/Intestinal Failure in Pediatrics 2026
• FDA News: FDA Warning for FMT, IB-Stim Device Approval, Teduglutide Approval (2019)
• Is GLP2 Worth $300K per Year? | gutsandgrowth