Teduglutide (Gattex / Revestive)

GLP-2 (glucagon-like peptide 2) is co-encoded with GLP-1 in the proglucagon gene but has entirely different biological effects: where GLP-1 regulates appetite and insulin secretion, GLP-2 promotes intestinal epithelial growth, increases villus height, deepens crypts, and enhances nutrient absorption capacity. Teduglutide is a recombinant GLP-2 analogue with a proline substitution that extends its half-life from approximately 7 minutes (native GLP-2) to approximately 2 hours.

Short bowel syndrome (SBS) with intestinal failure results from surgical resection of significant lengths of small bowel (trauma, Crohn's disease, mesenteric ischaemia, necrotising enterocolitis) leaving insufficient absorptive surface for adequate nutrition absorption. Patients require parenteral nutrition (IV feeding) to survive. Teduglutide promotes the remaining bowel to hypertrophy and absorb more efficiently, enabling reduction or elimination of parenteral nutrition dependence.

Clinical trials demonstrated that teduglutide treatment reduced parenteral nutrition requirements by approximately 4.4 hours per week versus placebo in SBS-IF patients, with approximately 63% of teduglutide patients achieving clinically meaningful PN reduction. This makes it one of the very few pharmaceutical agents that can modify the course of intestinal failure rather than merely managing its consequences.