A safety and pharmacokinetic dosing study of glucagon-like peptide 2 in infants with intestinal failure

TY - JOUR

T1 - A safety and pharmacokinetic dosing study of glucagon-like peptide 2 in infants with intestinal failure

AU - Sigalet, David L

AU - Brindle, Mary E

AU - Boctor, Dana

AU - Dicken, Bryan

AU - Lam, Viona

AU - Lu, Lily Sia

AU - de Heuvel, Elaine

AU - Hartmann, Bolette

AU - Holst, Jens J

N1 - Copyright © 2017 Elsevier Inc. All rights reserved.

PY - 2017/5

Y1 - 2017/5

N2 - BACKGROUND & AIMS: Glucagon-like peptide 2 (GLP-2) analogues are approved for adults with intestinal failure (IF), but no studies have included infants. This study examined the pharmacokinetics (PK), safety, and nutritional effects of GLP-2 in infants with IF.METHODS: With parental consent (Health Canada Protocol:150,979), parenteral nutrition (PN)-dependent infants were treated with 5-20-μg/kg/day GLP-2 for 3days (phase 1), and if tolerated continued for 42days (phase 2). Nutritional therapy was by primary caregivers, and follow-up was to one year.RESULTS: Six patients were enrolled, age 5.4±3.2months, bowel length: 27±12% of predicted, PN dependent (67±18% of calories). GLP-2 did not affect vital signs, nor were there significant adverse events during the trial. Dosing 5μg/kg/day gave GLP-2 levels of 52-57pmol/L, with no change in half-life or endogenous GLP-2 levels. Enteral feeds, weight, Z scores, stooling frequency, and citrulline levels improved numerically. The trial was discontinued early because of a drop in potency.CONCLUSIONS: GLP-2 was well tolerated in infants, and pK was similar to children with no changes in endogenous GLP-2 release. The findings suggest that GLP-2 ligands may be safely used in infants and may have beneficial effects on nutritional status. Further study is required.LEVEL OF EVIDENCE: 2b Prospective Interventional Study.

AB - BACKGROUND & AIMS: Glucagon-like peptide 2 (GLP-2) analogues are approved for adults with intestinal failure (IF), but no studies have included infants. This study examined the pharmacokinetics (PK), safety, and nutritional effects of GLP-2 in infants with IF.METHODS: With parental consent (Health Canada Protocol:150,979), parenteral nutrition (PN)-dependent infants were treated with 5-20-μg/kg/day GLP-2 for 3days (phase 1), and if tolerated continued for 42days (phase 2). Nutritional therapy was by primary caregivers, and follow-up was to one year.RESULTS: Six patients were enrolled, age 5.4±3.2months, bowel length: 27±12% of predicted, PN dependent (67±18% of calories). GLP-2 did not affect vital signs, nor were there significant adverse events during the trial. Dosing 5μg/kg/day gave GLP-2 levels of 52-57pmol/L, with no change in half-life or endogenous GLP-2 levels. Enteral feeds, weight, Z scores, stooling frequency, and citrulline levels improved numerically. The trial was discontinued early because of a drop in potency.CONCLUSIONS: GLP-2 was well tolerated in infants, and pK was similar to children with no changes in endogenous GLP-2 release. The findings suggest that GLP-2 ligands may be safely used in infants and may have beneficial effects on nutritional status. Further study is required.LEVEL OF EVIDENCE: 2b Prospective Interventional Study.

KW - Journal Article

U2 - 10.1016/j.jpedsurg.2017.01.034

DO - 10.1016/j.jpedsurg.2017.01.034

M3 - Journal article

C2 - 28209419

SN - 0022-3468

VL - 52

SP - 749

EP - 754

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

IS - 5

ER -