A113 TEDUGLUTIDE IN PATIENTS WITH ACTIVE CROHN’S DISEASE AND SHORT BOWEL SYNDROME

A113 TEDUGLUTIDE IN PATIENTS WITH ACTIVE CROHN'S DISEASE AND SHORT BOWEL SYNDROME S. Al Draiweesh, C. Ma, J.C. Gregor, A. Rahman, V. Jairath Background: Patients with Crohn’s disease (CD) are at risk of surgery due to refractory or penetrating disease, which may result in short bowel syndrome (SBS) that requires parenteral nutrition (PN). Teduglutide is a GLP2 analogue that has been approved for the treatment of SBS although there has been limited evidence for its use in CD patients. There is a theoretical risk of exacerbating mucosal inflammation with teduglutide due to intestinotrophic effects of GLP2. Aims: To assess the safety and efficacy of combined biologic therapy and teduglutide in patients with active CD and SBS. Methods: We present two cases of CD patients with active inflammation and SBS treated with combination biologic therapy and teduglutide. Results: The first case is a 38-year-old male with ileocolic stricturing CD, who previously failed methotrexate, azathioprine, infliximab and adalimumab. He underwent multiple small bowel and ileocolic resections resulting in SBS and was initiated on 7-day home parenteral nutrition (PN) in 2011 for SBS. Teduglutide was commenced in January 2017 and he was able to wean completely off PN within seven months. Ileocolic anastomotic inflammation was treated with ustekinumab in July 2017, and both treatments have been maintained for 14 months without any adverse events. The second case is a 39-year-old male with stricturing small bowel CD, who previously methotrexate, azathioprine failed infliximab, adalimumab, , and was steroid-dependent. After multiple small bowel resections, he was left with a jejunocolic anastomosis with approximately 60 cm of residual small bowel length. Daily PN was initiated in 2003. He was initiated on vedolizumab and 6mercaptopurine in 2016 due to pancolonic ulcerations. Teduglutide was added in August 2017 with significant clinical improvement in his oral intake, reduced stool output, and 4kg weight gain, with reduction in PN requirements to one night/week within 12 months of teduglutide. Conclusions: These two cases suggest that teduglutide may be safe, effective and can be used with concomitant biologic agents and immunosuppressants in patients with active CD and SBS. However, longer term follow-up and more reports are needed to evaluate the safety of teduglutide in this setting. Gastroenterology, Western University, London, ON, Canada Funding Agencies: None  (...truncated)