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approvedGI & Metabolic

Teduglutide

Also known as: Gattex, Revestive, ALX-0600

Teduglutide is a recombinant analog of human glucagon-like peptide-2 (GLP-2) with an alanine-to-glycine substitution at position 2 that confers resistance to DPP-4 degradation, extending its half-life to approximately 2 hours compared to 7 minutes for native GLP-2. FDA-approved in 2012 (Gattex in the US, Revestive in Europe), teduglutide is the first and only GLP-2 analog approved for the treatment of short bowel syndrome (SBS) in adults and children dependent on parenteral nutrition. It promotes intestinal adaptation by stimulating villus growth, increasing crypt cell proliferation, and enhancing nutrient absorption.

3 cited references·5 researched benefits

Quick Answer

Teduglutide (Gattex/Revestive) is a GLP-2 analog FDA-approved for short bowel syndrome (SBS) in patients dependent on parenteral nutrition. It stimulates intestinal mucosal growth — increasing villus height, crypt depth, and nutrient absorption — enabling 65% of patients to reduce parenteral nutrition volume by at least 20%. Some patients achieve full enteral autonomy. Administered as a daily subcutaneous injection, it is the only approved intestinotrophic therapy that promotes structural intestinal adaptation.

Key Facts

Mechanism
Teduglutide binds the GLP-2 receptor (GLP-2R), a class B GPCR expressed on enteric neurons, subepithelial myofibroblasts, and intestinal endocrine cells (but notably not on enterocytes directly). GLP-2R activation triggers a paracrine cascade: subepithelial myofibroblasts release growth factors (IGF-1, KGF/FGF-7, EGF) that stimulate crypt cell proliferation and inhibit enterocyte apoptosis, resulting in villus elongation and increased absorptive surface area. Teduglutide also slows gastric emptying, reduces gastric acid secretion, increases intestinal blood flow, and enhances expression of nutrient transporters (SGLT1, GLUT2, peptide transporters). The Gly² substitution prevents DPP-4 cleavage, extending the half-life from ~7 minutes (native GLP-2) to ~2 hours, allowing once-daily dosing.
Research Status
approved
Half-Life
~2 hours
Molecular Formula
C₁₆₄H₂₅₂N₄₄O₅₅S
Primary Use
GI & Metabolic
Table of Contents

Benefits

  • Parenteral nutrition reduction — 65% of SBS patients achieve ≥20% reduction in parenteral nutrition volume; mean reduction of 4.4 L/weekstrong
  • Enteral autonomy — approximately 10–30% of treated SBS patients achieve complete independence from parenteral nutrition over 2+ yearsstrong
  • Intestinal structural adaptation — documented increases in villus height, crypt depth, and overall mucosal thickness on serial biopsiesstrong
  • Improved fluid and electrolyte absorption — reduces fecal wet weight and increases urinary output, indicating enhanced intestinal absorptionstrong
  • Reduced catheter-related complications — by decreasing parenteral nutrition dependence, teduglutide indirectly reduces central line infections, thrombosis, and liver diseasemoderate

Dosage Protocols

RouteDosage RangeFrequencyNotes
Subcutaneous injection (adults)0.05 mg/kg/dayOnce dailyMaximum recommended dose is 0.05 mg/kg/day. Dose should be reduced by 50% in patients with moderate-to-severe renal impairment (CrCl <50 mL/min). Parenteral nutrition should be reduced in a stepwise manner as intestinal absorption improves; monitor fluid status closely.
Subcutaneous injection (pediatric, ≥1 year)0.05 mg/kg/dayOnce dailyFDA-approved for pediatric patients ≥1 year old with SBS dependent on parenteral nutrition. Same weight-based dosing as adults. Requires close monitoring of growth, fluid balance, and nutritional status by a multidisciplinary team.

Medical disclaimer

Dosage information is provided for educational reference only. Always follow your prescriber's instructions and consult a qualified healthcare provider before starting any peptide protocol.

Side Effects

  • Abdominal pain and distension — reported in 30–40% of patients, typically mild and improving over weekscommon
  • Nausea — occurs in 20–30% of patients, generally during the first weeks of therapycommon
  • Injection-site reactions — erythema, swelling, or pain at the subcutaneous injection sitecommon
  • Intestinal polyps — colorectal polyps observed in 3–5% of patients; colonoscopy required at baseline, 1 year, and then every 5 yearsserious
  • Potential neoplasia risk — GLP-2R is expressed on some GI tumors; teduglutide is contraindicated in patients with active GI malignancyserious
  • Gallbladder and biliary complications — cholecystitis, cholangitis, and cholelithiasis reported in some patientsrare

Frequently Asked Questions

What is short bowel syndrome and who needs teduglutide?
Short bowel syndrome (SBS) occurs when a significant portion of the small intestine is surgically removed (typically >50%) or is non-functional, resulting in malabsorption of nutrients, fluids, and electrolytes. Common causes include Crohn's disease, mesenteric ischemia, radiation enteritis, and neonatal conditions (necrotizing enterocolitis, volvulus). Patients with SBS often require long-term parenteral nutrition (IV feeding) to survive, which carries risks including central line infections, liver disease, and metabolic complications. Teduglutide is indicated for SBS patients who are dependent on parenteral nutrition and have stable intestinal anatomy.
How long does teduglutide take to work?
Intestinal adaptation with teduglutide is gradual. In clinical trials, statistically significant reductions in parenteral nutrition volume were observed by week 20–24. However, maximum benefit may take 1–2+ years of continuous treatment, as structural intestinal adaptation (villus growth, mucosal thickening) is a slow biological process. Parenteral nutrition should be reduced gradually based on clinical response — monitored by urine output (>1 L/day target), weight stability, and biochemical markers. Abrupt parenteral nutrition discontinuation is dangerous; reductions should be guided by experienced SBS teams.
Why does teduglutide require colonoscopy monitoring?
Because GLP-2 receptor activation stimulates crypt cell proliferation throughout the intestine, there is a theoretical concern about promoting growth of pre-existing colorectal polyps or neoplasms. In clinical trials, colorectal polyps were observed in 3–5% of teduglutide-treated patients. The FDA labeling requires colonoscopy (or alternative imaging) at baseline within 6 months before starting therapy, at the end of the first year, and then every 5 years thereafter. Teduglutide is contraindicated in patients with active GI malignancy. Any new polyps should be removed and evaluated histologically before continuing treatment.
What is the difference between GLP-1 and GLP-2?
GLP-1 and GLP-2 are co-secreted from intestinal L-cells (processed from the same proglucagon precursor) but have very different functions. GLP-1 acts primarily on the pancreas (insulin secretion), brain (appetite suppression), and stomach (gastric emptying delay) — hence its use in diabetes and obesity (semaglutide, tirzepatide). GLP-2 acts primarily on the intestine itself, promoting mucosal growth, nutrient absorption, and intestinal blood flow. GLP-1 analogs are metabolic drugs; teduglutide (GLP-2 analog) is an intestinotrophic drug. They share the same DPP-4 degradation vulnerability, which is why both native GLP-1 and GLP-2 have very short half-lives.

References

  1. 1
    Teduglutide for the treatment of short bowel syndrome (pivotal phase 3 trial)(2012)PubMed ↗
  2. 2
    Long-term efficacy and safety of teduglutide in patients with short bowel syndrome(2014)PubMed ↗
  3. 3
    GLP-2 and intestinal adaptation: mechanisms and therapeutic implications(2006)PubMed ↗

Latest Research

Last updated: 2026-02-19