Teduglutide
An FDA-approved GLP-2 receptor agonist that regrows intestinal mucosa to restore absorptive capacity in short bowel syndrome.
Teduglutide (Gattex in the United States, Revestive in the European Union) is a GLP-2 analogue and FDA-approved prescription medication for short bowel syndrome (SBS) with intestinal failure in adults and pediatric patients aged 1 year and older. It works by promoting intestinal mucosal growth and enhancing the absorptive capacity of residual bowel, thereby reducing dependence on parenteral nutrition and intravenous fluids. Phase 3 registrational trials and long-term extension studies have documented durable reductions in parenteral support requirements.
Class
Synthetic GLP-2 (glucagon-like peptide-2) analogue
Half-life
~2 hours
Routes
Subcutaneous
Category
Healing & Recovery
Researched benefits
What it's studied for
Intestinal mucosal growth
Activates GLP-2 receptors on intestinal subepithelial myofibroblasts and enteric neurons, driving enterocyte crypt cell proliferation and increasing villus height to expand the mucosal absorptive surface.
Reduced parenteral nutrition dependence
Phase 3 trials and the STEPS-2 extension documented significant, durable reductions in weekly parenteral support volume, with some patients achieving complete enteral autonomy.
Improved nutrient and fluid absorption
By enlarging absorptive surface area in functionally compromised residual bowel, teduglutide improves absorption of nutrients and fluids from the gut.
Gut repair and adaptation
Stimulates paracrine release of IGF-1 and keratinocyte growth factor (KGF) while reducing epithelial apoptosis, supporting intestinal adaptation after resection or in congenital enteropathy.
Increased intestinal blood flow
Enhances mesenteric and intestinal blood flow and inhibits gastric motility, contributing to greater retention and uptake of luminal contents.
Mechanism
How it works
Teduglutide is an analogue of glucagon-like peptide-2 (GLP-2), a hormone released by intestinal L-cells that regulates the growth and integrity of the gut lining. It resists degradation by the enzyme dipeptidyl peptidase-4, giving it a longer duration of action than native GLP-2 while retaining its biological activity at the GLP-2 receptor.
The peptide binds GLP-2 receptors expressed on intestinal subepithelial myofibroblasts and enteric neurons. Receptor activation triggers paracrine release of insulin-like growth factor 1 (IGF-1) and keratinocyte growth factor (KGF), which act on neighboring crypt cells to stimulate proliferation, increase villus height, and reduce enterocyte apoptosis.
The net effect is expansion of the mucosal absorptive surface area, increased intestinal and mesenteric blood flow, and inhibition of gastric motility. Together these actions improve the capacity of a shortened or functionally compromised residual bowel to absorb nutrients and fluids, reducing the volume of parenteral nutrition and intravenous fluid a patient requires.
Dosing protocols
Dosing & administration
Dosing reflects protocols reported in research and community literature for educational purposes. It is not medical advice or a recommendation. Most peptides here are not approved for human use.
Clinical (approved indication)
- Dose
- Prescriber-determined, weight-based
- Frequency
- Once daily
- Timing
- Same time each day; rotate injection sites
- Duration
- Long-term / ongoing
- Route
- Subcutaneous
Administered as a daily subcutaneous injection under physician supervision for short bowel syndrome. Specific dosing is individualized and set by the prescriber; the source material does not provide a numeric regimen.
- Teduglutide is a prescription medication administered by daily subcutaneous injection and should only be used under qualified medical supervision.
- Colorectal polyps should be assessed before starting and monitored during treatment.
- Emerging longer-acting GLP-2 agents are being investigated as alternatives with less frequent dosing requirements.
Evidence
Research & clinical studies (7)
From childhood to adulthood in chronic intestinal failure: A nationwide study
Teduglutide was the only therapeutic factor associated with reduced dependence on home parenteral nutrition in adults with childhood-onset chronic intestinal failure, where survival remained high (91%) but PN dependence (95%) was common.
PMID 42105609A Long-Acting Glucagon-like Peptide 2 Protracted by Coomassie Brilliant Blue to Enhance Intestinal Growth in Mice
A modified teduglutide conjugated with Coomassie brilliant blue showed extended circulation time and enhanced intestinal growth in mice compared with standard teduglutide, suggesting potential for reduced injection frequency.
PMID 41961990Real-world experience of teduglutide for the treatment of short bowel syndrome-associated intestinal failure
In real-world practice, both teduglutide-treated and untreated SBS patients reduced PN/IV dependence over ~19 months, with treated patients showing slightly higher reductions in energy received from parenteral support.
PMID 42167731PERCC1-associated enteropathy: Diagnostic challenges and enteral autonomy achieved with teduglutide
Teduglutide enabled a child with a novel PERCC1 gene mutation causing severe congenital enteropathy to achieve independence from parenteral nutrition after two years of dependency.
PMID 42110144Glucagon-like peptide agonists and use in short bowel syndrome - what about the side effects?
GLP-2 agonists, particularly teduglutide, improve intestinal absorption and reduce parenteral support needs with favorable safety profiles, while emerging longer-acting agents offer less frequent dosing.
PMID 41866997Long-Term Teduglutide for the Treatment of Patients With Intestinal Failure Associated With Short Bowel Syndrome
In the STEPS-2 open-label extension, up to 30 months of teduglutide reduced mean weekly parenteral support volume by 66% in continuous-treatment patients, with 13 achieving complete enteral autonomy.
PMID 26844839Teduglutide for Safe Reduction of Parenteral Nutrient and/or Fluid Requirements in Adults: A Systematic Review
A systematic review of phase 3 RCTs and extension studies found teduglutide consistently reduced parenteral nutrition requirements versus placebo with an adverse event profile comparable to placebo.
PMID 25883117Safety
Side effects & considerations
Commonly reported effects
Contraindications & cautions
- Active or history of gastrointestinal malignancy
- Colorectal polyps (require monitoring)
Because teduglutide promotes intestinal cell proliferation, it carries a moderate risk profile requiring careful screening and monitoring. Patients should be assessed for GI malignancy and colorectal polyps before and during treatment, and it should only be used under physician supervision.
FAQ
Teduglutide — common questions
What is Teduglutide?
Teduglutide (Gattex in the US, Revestive in the EU) is a GLP-2 analogue and FDA-approved prescription medication for short bowel syndrome with intestinal failure in adults and pediatric patients. It promotes intestinal mucosal growth and enhances absorptive capacity, reducing dependence on parenteral nutrition and IV fluids.
How does Teduglutide work?
It activates GLP-2 receptors on intestinal subepithelial myofibroblasts and enteric neurons, stimulating paracrine release of IGF-1 and keratinocyte growth factor. This drives crypt cell proliferation, increases villus height, reduces apoptosis, and expands the mucosal absorptive surface area.
What is Teduglutide primarily studied for?
Intestinal growth, gut repair, absorptive surface restoration, and short bowel syndrome treatment.
How is Teduglutide administered?
It is given as a once-daily subcutaneous injection under physician supervision. Dosing is individualized by the prescriber.
What are the side effects and contraindications of Teduglutide?
It carries a moderate risk profile. Reported contraindications and considerations include active or prior gastrointestinal malignancy and colorectal polyps, which require monitoring. Consult a qualified healthcare professional before use.
What does the research show about Teduglutide?
Phase 3 trials, the STEPS-2 long-term extension, and real-world studies show teduglutide reduces parenteral nutrition and IV fluid requirements, with some patients achieving complete enteral autonomy. A nationwide study identified it as the only factor associated with reduced home parenteral nutrition dependence in adults with childhood-onset intestinal failure.
Is Teduglutide FDA approved?
Yes. It was approved by the FDA on December 21, 2012 (Gattex, NDA 203441) for short bowel syndrome in adults and pediatric patients, and is available by prescription only.
