Teduglutide is a glucagon-like peptide-2 (GLP-2) analogue. It is made up of 33 amino acids and is manufactured using a strain of Escherichia coli modified by recombinant DNA technology. Teduglutide differs from GLP-2 by one amino acid (alanine is substituted by glycine). The significance of this substitution is that teduglutide is longer acting than endogenous GLP-2 as it is more resistant to proteolysis from dipeptidyl peptidase-4. FDA approved on December 21, 2012.

Protein chemical formula

C₁₆₄H₂₅₂N₄₄O₅₅S

Protein average weight

3752.0 Da

Sequences

>Protein sequence for teduglutide
HGDGSFSDEMNTILDNLAARDFINWLIQTKITD

Download FASTA Format

Synonyms

(Gly2)GLP-2
Glucagon-like peptide II (2-glycine) (human)
Gly(2)-GLP-2
Teduglutide [rDNA origin]
Teduglutide Recombinant

External IDs

ALX 0600 / ALX-0600

Prescription Products

Name	Dosage	Strength	Route	Labeller	Marketing Start	Marketing End
Gattex	Injection, powder, lyophilized, for solution	5 mg/0.5mL	Subcutaneous	Shire-NPS Pharmaceuticals, Inc.	2012-12-21	Not applicable
Revestive	Injection, powder, for solution	5 mg	Subcutaneous	Shire	2012-08-30	Not applicable
Revestive	Kit; Powder, for solution	5 mg	Subcutaneous	Shire Pharmaceuticals Ireland Limited	2015-10-28	Not applicable

Mixture Products

Name	Ingredients	Dosage	Route	Labeller	Marketing Start	Marketing End
Gattex	Teduglutide (5 mg/0.5mL) + Ethanol (0.7 mL/1mL)	Kit		Shire-NPS Pharmaceuticals, Inc.	2012-12-21	Not applicable
Gattex	Teduglutide (5 mg/0.5mL) + Ethanol (0.7 mL/1mL)	Kit		Shire-NPS Pharmaceuticals, Inc.	2012-12-21	Not applicable

International/Other Brands

Gattex / Revestive

Categories

UNII

7M19191IKG

CAS number

197922-42-2

Pharmacology

Indication

Treatment of short bowel syndrome (SBS), malabsorption associated with the removal of the intestine, in adults patients who are dependent on parenteral support.

Associated Conditions

Short Bowel Syndrome (SBS)

Pharmacodynamics

An enhancement of gastrointestinal fluid absorption (750-1000 mL/day) was observed following daily administrations of teduglutide. An increase in villus height and crypt depth of the intestinal mucosa was also noted. A decrease in fecal weight has also been observed. Teduglutide does not prolong the QTc interval.

Mechanism of action

Teduglutide is an analog of naturally occurring human glucagon-like peptide-2 (GLP-2), a peptide secreted by L-cells of the distal intestine in response to meals. GLP-2 increases intestinal and portal blood flow and inhibit gastric acid secretion. Teduglutide binds to the glucagon-like peptide-2 receptors located in enteroendocrine cells, subepithelial myofibroblasts and enteric neurons of the submucosal and myenteric plexus. This causes the release of insulin-like growth factor (IGF)-1, nitric oxide and keratinocyte growth factor (KGF). These growth factors may contribute to the increase in crypt cell growth and surface area of the gastric mucosa. Ultimately, absorption through the intestine is enhanced.

Target	Actions	Organism
AGlucagon-like peptide 2 receptor	agonist	Human

Absorption

The pharmacokinetic profile of teduglutide (when administered subcutaneously) is described by a one-compartment model with first order absorption in the abdomen, arm, and thigh. With escalating doses, teduglutide demonstrates linear pharmacokinetics. Absolute bioavailability, SubQ = 88%; Tmax, SubQ = 3-5 hours;
Cmax, 0.05 mg/kg SubQ, SBS patients = 36 ng/mL; AUC, 0.05 mg/kg SubQ, SBS patients = 0.15 µg•hr/mL; Teduglutide does not accumulate following multiple subcutaneous administrations.

Volume of distribution

Vd, healthy subjects = 103 mL/kg

Protein binding

Not Available

Metabolism

Although a formal investigation has not been conducted, it is expected because teduglutide is a peptide-based drug, it will be degraded into smaller peptides and amino acids via catabolic pathways. The cytochrome P450 enzyme system is not involved in the metabolism of this drug.

Route of elimination

Urine

Half life

Terminal half-life, healthy subjects = 2 hours; Terminal half-life, SBS patients = 1.3 hours

Clearance

Plasma clearance, healthy subjects = 123 mL/hr/kg; This value indicates that teduglutide is primarily cleared by the kidney.

Toxicity

The most common adverse reactions (≥ 10%) across all studies with GATTEX are abdominal pain, injection site reactions, nausea, headaches, abdominal distension, upper respiratory tract infection. In addition, vomiting and fluid overload were reported in the SBS studies (1 and 3) at rates ≥ 10%.

Affected organisms

Humans and other mammals

Pathways

Not Available

Pharmacogenomic Effects/ADRs

Not Available

Interactions

Drug Interactions

Drug	Interaction
Acetaminophen	Acetaminophen may decrease the excretion rate of Teduglutide which could result in a higher serum level.
Acetylsalicylic acid	Acetylsalicylic acid may decrease the excretion rate of Teduglutide which could result in a higher serum level.
Alprazolam	The serum concentration of Alprazolam can be increased when it is combined with Teduglutide.
Amiloride	Amiloride may increase the excretion rate of Teduglutide which could result in a lower serum level and potentially a reduction in efficacy.
Amitriptyline	Teduglutide may decrease the excretion rate of Amitriptyline which could result in a higher serum level.
Amlodipine	Amlodipine may decrease the excretion rate of Teduglutide which could result in a higher serum level.
Amoxicillin	Amoxicillin may decrease the excretion rate of Teduglutide which could result in a higher serum level.
Amphetamine	Amphetamine may decrease the excretion rate of Teduglutide which could result in a higher serum level.
Ampicillin	Ampicillin may decrease the excretion rate of Teduglutide which could result in a higher serum level.
Auranofin	Auranofin may decrease the excretion rate of Teduglutide which could result in a higher serum level.

Food Interactions

Not Available

References

General References

Burness CB, McCormack PL: Teduglutide: a review of its use in the treatment of patients with short bowel syndrome. Drugs. 2013 Jun;73(9):935-47. doi: 10.1007/s40265-013-0070-y. [PubMed:23729002]
Semrad CE: The long road to a new short-bowel therapy: teduglutide for clinical use. Clin Gastroenterol Hepatol. 2013 Jul;11(7):824-5. doi: 10.1016/j.cgh.2013.03.030. Epub 2013 Apr 13. [PubMed:23591284]
Jeppesen PB: Teduglutide, a novel glucagon-like peptide 2 analog, in the treatment of patients with short bowel syndrome. Therap Adv Gastroenterol. 2012 May;5(3):159-71. doi: 10.1177/1756283X11436318. [PubMed:22570676]

External Links

KEGG Drug: D06053
KEGG Compound: C16049
PubChem Substance: 347910383
ChEBI: 72305
ChEMBL: CHEMBL2104987
RxList: RxList Drug Page
Drugs.com: Drugs.com Drug Page
Wikipedia: Teduglutide

ATC Codes

A16AX08 — Teduglutide

AHFS Codes

56:92.00 — Miscellaneous GI Drugs

FDA label

Download (410 KB)

Clinical Trials

Clinical Trials

Phase	Status	Purpose	Conditions	Count
1	Completed	Not Available	Healthy Volunteers	1
1	Completed	Not Available	Hepatic Impairment	1
1	Completed	Not Available	Impaired Renal Function	1
1	Completed	Not Available	Pharmacokinetics and Safety of Elevated Doses	1
1	Completed	Treatment	Healthy Volunteers	1
1	Not Yet Recruiting	Treatment	Postoperative Fistula	1
2	Completed	Treatment	Crohn's Disease (CD)	2
2	Recruiting	Treatment	Human Immunodeficiency Virus (HIV)	1
2, 3	Not Yet Recruiting	Basic Science	Hyperlipidemias	2
2, 3	Recruiting	Basic Science	Hyperlipidemias	1
3	Active Not Recruiting	Treatment	Short Bowel Syndrome (SBS)	2
3	Completed	Treatment	Short Bowel Syndrome (SBS)	7
3	Enrolling by Invitation	Treatment	Short Bowel Syndrome (SBS)	1
3	Recruiting	Treatment	Short Bowel Syndrome (SBS)	4
4	Completed	Treatment	Short Bowel Syndrome (SBS)	1
4	Not Yet Recruiting	Treatment	Short Bowel Syndrome (SBS)	1

Pharmacoeconomics

Manufacturers

Not Available

Packagers

Not Available

Dosage forms

Form	Route	Strength
Injection, powder, lyophilized, for solution	Subcutaneous	5 mg/0.5mL
Kit
Injection, powder, for solution	Subcutaneous	5 mg
Kit; powder, for solution	Subcutaneous	5 mg

Prices

Not Available

Patents

Patent Number	Pediatric Extension	Approved	Expires (estimated)
US5789379	No	1996-04-14	2016-04-14
US7056886	No	2002-09-18	2022-09-18
US7847061	No	2005-11-01	2025-11-01
US9060992	No	2005-11-01	2025-11-01
US9555079	No	2005-11-01	2025-11-01
US9545434	No	2005-11-01	2025-11-01
US9539310	No	2005-11-01	2025-11-01
US9545435	No	2005-11-01	2025-11-01
US9592273	No	2005-11-01	2025-11-01
US9592274	No	2005-11-01	2025-11-01
US9572867	No	2005-11-01	2025-11-01
US9987334	No	2005-11-01	2025-11-01
US9968658	No	2005-11-01	2025-11-01
US9981016	No	2005-11-01	2025-11-01
US9974837	No	2005-11-01	2025-11-01
US9974835	No	2005-11-01	2025-11-01
US9981014	No	2005-11-01	2025-11-01
US9968656	No	2005-11-01	2025-11-01
US9968655	No	2005-11-01	2025-11-01
US9987335	No	2005-11-01	2025-11-01
US9993528	No	2005-11-01	2025-11-01

Properties

State: Liquid
Experimental Properties: Not Available

Taxonomy

Description: Not Available
Kingdom: Organic Compounds
Super Class: Organic Acids
Class: Carboxylic Acids and Derivatives
Sub Class: Amino Acids, Peptides, and Analogues
Direct Parent: Peptides
Alternative Parents: Not Available
Substituents: Not Available
Molecular Framework: Not Available
External Descriptors: Not Available

Targets

Details1. Glucagon-like peptide 2 receptor

Kind: Protein
Organism: Human
Pharmacological action: Yes
Actions: Agonist

General Function: Glucagon receptor activity
Specific Function: This is a receptor for glucagon-like peptide 2. The activity of this receptor is mediated by G proteins which activate adenylyl cyclase.
Gene Name: GLP2R
Uniprot ID: O95838
Uniprot Name: Glucagon-like peptide 2 receptor
Molecular Weight: 63000.84 Da

References

Burness CB, McCormack PL: Teduglutide: a review of its use in the treatment of patients with short bowel syndrome. Drugs. 2013 Jun;73(9):935-47. doi: 10.1007/s40265-013-0070-y. [PubMed:23729002]

Drug created on June 05, 2013 23:11 / Updated on September 21, 2018 00:15