GLP-1 gets the headlines, but its sibling hormone GLP-2 tells the small intestine to grow and absorb more. Here is how teduglutide works, what the STEPS, STEPS-2 and pediatric trials found about cutting IV nutrition, and why the label requires regular colonoscopies.
Teduglutide, sold as Gattex, is a GLP-2 analog peptide that the FDA has approved for adults and children 1 year of age and older with short bowel syndrome who depend on parenteral support, which means nutrition or fluids given through a vein. You have probably heard far more about GLP-1, the hormone behind semaglutide and tirzepatide, than about its sibling. GLP-2 has a quieter job, because it tells the lining of your small intestine to grow and absorb more, and teduglutide is a longer lasting version of that signal that reached the market with an initial U.S. approval in 2012.
The research question behind teduglutide is easy to state. If someone has lost so much bowel that they need IV feeding to survive, can a peptide make the remaining bowel work hard enough to cut back on the IV bags? The STEPS trials suggest that it often can, at least partly. This article walks you through how teduglutide works, what the main trials found in adults and children, the safety warnings on the label and the newer GLP-2 drugs that follow it. It is educational content about published research rather than medical advice, and teduglutide is a prescription drug used under close specialist supervision.
Key takeaways
What it is
A 33 amino acid GLP-2 analog (Gattex), FDA indicated since 2012 for people 1 year of age and older with short bowel syndrome who depend on parenteral support. The labeled dose is 0.05 mg/kg once daily by subcutaneous injection.
Pivotal STEPS trial
63% of adults on teduglutide cut weekly IV volume by more than 20% at weeks 20 and 24, compared with 30% on placebo.
STEPS-2 extension
28 of 30 completers who took teduglutide from the start (93%) were responders, with a mean drop of 7.6 L/week (66%), and 13 patients came off parenteral support entirely.
Children
In a 24 week phase 3 trial, 69.2% of children on 0.05 mg/kg reached at least a 20% reduction in parenteral support, compared with 11.1% on standard care.
Monitoring
Adults need colonoscopy and upper GI endoscopy within 6 months before starting, again at 1 year and then every 5 years, because GLP-2 drives tissue growth and rodent studies showed tumor findings.
Sources: Gattex prescribing information, DailyMed, 2025; Jeppesen and colleagues, Gastroenterology, 2012; Schwartz and colleagues, Clinical and Translational Gastroenterology, 2016; Kocoshis and colleagues, JPEN, 2020.
Teduglutide is a lab made version of human GLP-2 that has been altered so it survives longer in your blood. According to the Gattex prescribing information on DailyMed, teduglutide is a 33 amino acid analog of GLP-2 that is produced in E. coli using recombinant DNA technology. Native GLP-2 is secreted by L cells in the distal intestine, which are the same cells that release GLP-1 after you eat.
The two hormones divide the work between them. GLP-1 acts mainly on appetite, insulin and stomach emptying, which is why it became the basis for semaglutide and tirzepatide, and our [semaglutide explainer](https://www.peptidepeppers.com/articles/semaglutide-glp-1-explained) covers that side of the family. GLP-2 acts mainly on the gut itself. Your body breaks native GLP-2 down quickly with an enzyme called dipeptidyl peptidase IV, so teduglutide was designed as "a dipeptidyl peptidase IV resistant GLP-2 analogue," as the 2005 pilot study in Gut described it, which lets the growth signal last long enough to be useful with one daily injection.
Even so, teduglutide is short lived by modern peptide standards. The label lists a mean terminal half life of about 2 hours in healthy people and 1.3 hours in people with short bowel syndrome, with clearance mostly through the kidneys. Our guide to [peptide half life and dosing frequency](https://www.peptidepeppers.com/articles/peptide-half-life-dosing-frequency) explains why a half life measured in hours can still support once daily dosing when the downstream effect, which here is tissue growth, lasts much longer than the drug itself.
Teduglutide works by switching on GLP-2 receptors in the gut wall, which sets off a local cascade of growth signals. The label says that activation of these receptors "results in the local release of multiple mediators including insulin-like growth factor (IGF)-1, nitric oxide and keratinocyte growth factor (KGF)." Those receptors sit on enteroendocrine cells, subepithelial myofibroblasts and enteric neurons rather than on the absorbing cells themselves, so the effect on absorption is indirect.
The visible result is taller villi and deeper crypts, the finger shaped folds and small pockets that give your small intestine its absorbing surface. In the 2005 pilot published in Gut by Jeppesen and colleagues ([doi.org/10.1136/gut.2004.061440](https://doi.org/10.1136/gut.2004.061440)), 16 patients with short bowel syndrome received teduglutide for 21 days. Wet weight absorption, which is the amount of fluid and food the gut took in, rose by 743 g/day on average, a relative increase of 22%, and biopsies showed villus height up 38%, crypt depth up 22% and the mitotic index, a measure of cell division, up 115%.
The same study found something important if you think of teduglutide as a repair peptide, because the gains did not last once the drug stopped. The authors reported that the improvements "had reversed after the drug free follow up period." The FDA label's own summary of the 21 day dose ranging study describes increased absorption of approximately 750 to 1000 mL/day at every dose except the lowest, 0.03 mg/kg. Teduglutide therefore behaves like a maintenance therapy rather than a treatment you take once and keep the benefit from.
"The improvements in absorption had reversed after the drug free follow up period, which makes teduglutide a maintenance therapy rather than a one time fix."
Average change after 21 days of teduglutide (%)
Pooled results from 16 patients with short bowel syndrome. Absolute wet weight absorption rose by 743 g/day, and the absorption gains reversed after the drug free follow up period. Source: Jeppesen and colleagues, Gut, 2005.
The first phase 3 trial, published in Gut in 2011 ([doi.org/10.1136/gut.2010.218271](https://doi.org/10.1136/gut.2010.218271)), found that the lower of two doses performed better on the main endpoint, and that result settled the dose used today. Jeppesen and colleagues randomized 83 adults with short bowel syndrome and intestinal failure to teduglutide 0.10 mg/kg/day (n = 32), 0.05 mg/kg/day (n = 35) or placebo (n = 16) for 24 weeks.
On the primary graded response score, the 0.05 mg/kg dose beat placebo (16/35, p = 0.007), while the 0.10 mg/kg dose did not reach significance (8/32 vs 1/16, p = 0.16). The authors pointed out that the actual reductions in parenteral volume were nearly identical at 353 and 354 ml/day, and that the higher dose group happened to start with larger IV needs, which may explain the gap. Three patients on teduglutide were weaned off parenteral support completely, and villus height, plasma citrulline and lean body mass all rose compared with placebo.
In a 52 week extension of that trial reported by O'Keefe and colleagues in Clinical Gastroenterology and Hepatology in 2013 ([doi.org/10.1016/j.cgh.2012.12.029](https://doi.org/10.1016/j.cgh.2012.12.029)), 68% of patients on 0.05 mg/kg/d and 52% on 0.10 mg/kg/d had at least a 20% reduction in parenteral nutrition, and four patients achieved complete independence from it. Headache was the most commonly reported adverse event, affecting 35% of participants.
The STEPS trial is the main study behind the 2012 approval, and it showed that teduglutide roughly doubled the share of adults who could meaningfully cut their IV support. Published by Jeppesen and colleagues in Gastroenterology in 2012 ([doi.org/10.1053/j.gastro.2012.09.007](https://doi.org/10.1053/j.gastro.2012.09.007)), STEPS randomized adults with short bowel syndrome and intestinal failure to teduglutide 0.05 mg/kg/day (n = 43) or placebo (n = 43) for 24 weeks. Doctors lowered IV volumes whenever 48 hour urine output rose by at least 10%, which was taken as a sign that the gut was absorbing more.
These patients were far from borderline cases. According to the Gattex label, the trial enrolled adults who had depended on parenteral support for at least 12 months and needed it at least 3 times per week. Their mean age was 50, they had been on IV nutrition for a mean of 6 years (range 1 to 26), the most common causes of their bowel loss were vascular disease (34%) and Crohn's disease (21%), and 45% had a stoma.
At week 24, 27 of 43 patients (63%) on teduglutide had more than a 20% reduction in parenteral volume at both week 20 and week 24, compared with 13 of 43 (30%) on placebo. Weekly IV volume fell by a mean of 4.4 L/wk from a baseline of 12.9 L/wk on teduglutide, versus 2.3 L/wk from a baseline of 13.2 L/wk on placebo, and 54% of the teduglutide group cut at least 1 day per week of IV infusion compared with 23% on placebo. Adverse events led to discontinuation in 2 teduglutide patients and 3 placebo patients.
STEPS trial results at week 24 (% of patients)
Responders had more than a 20% reduction in parenteral volume at weeks 20 and 24 (27/43 vs 13/43). Source: Jeppesen and colleagues, Gastroenterology, 2012.
The fact that the placebo group improved at all is worth noticing. Every patient had their IV regimen optimized and closely monitored, and that attention alone allowed some people to cut back, so the real effect of teduglutide is the gap between the two groups rather than the full drop you see in the treated group.
STEPS outcomes at week 24
| Outcome | Teduglutide (n = 43) | Placebo (n = 43) |
|---|---|---|
| Responders (more than 20% cut in IV volume) | 27/43 (63%) | 13/43 (30%) |
| Mean IV volume reduction | 4.4 L/wk | 2.3 L/wk |
| Baseline IV volume | 12.9 L/wk | 13.2 L/wk |
| At least 1 fewer IV day per week | 54% | 23% |
| Discontinued for adverse events | 2 | 3 |
Source: Jeppesen and colleagues, Gastroenterology, 2012.
The open label data suggest that the benefit grows with time rather than fading. STEPS-2, reported by Schwartz and colleagues in Clinical and Translational Gastroenterology in 2016 ([doi.org/10.1038/ctg.2015.69](https://doi.org/10.1038/ctg.2015.69)), was a 2 year extension that enrolled 88 patients, of whom 65 (74%) finished. Among completers who had taken teduglutide from the start of STEPS, 28 of 30 (93%) were responders, and their weekly IV volume had fallen by a mean of 7.6 L/week, a 66% reduction. Patients who switched from placebo to teduglutide had a mean reduction of 3.1 L/week (28%), and 13 patients across the study reached full enteral autonomy, which means they needed no IV support at all.
Two cautions apply when you read these numbers. STEPS-2 was open label with no control group, so it cannot separate the drug from the effect of continued specialist care, and the completers are by definition the people who stayed on treatment, which tends to flatter long term results. Mean weight, body mass index and serum albumin nonetheless held steady even as IV nutrition came down, which suggests that patients were absorbing enough to replace what the bags had supplied.
STEPS-2 completers: response and IV volume reduction (%)
Responders: 28/30, 16/29 and 4/6. Mean reductions were 7.6, 3.1 and 4.0 L/week. Open label, no control group. Source: Schwartz and colleagues, Clinical and Translational Gastroenterology, 2016.
Teduglutide has worked in the pediatric trials that have tested it, and the label now covers children 1 year of age and older. The 24 week pediatric phase 3 trial reported by Kocoshis and colleagues in JPEN in 2020 ([doi.org/10.1002/jpen.1690](https://doi.org/10.1002/jpen.1690)) enrolled 59 children with short bowel syndrome and intestinal failure into teduglutide 0.025 mg/kg (n = 24), teduglutide 0.05 mg/kg (n = 26) or standard of care (n = 9), and all 59 finished the study.
At week 24, at least a 20% reduction in parenteral support was reached by 54.2% of children on the lower dose, 69.2% on 0.05 mg/kg and 11.1% on standard care, and five children achieved enteral autonomy, 2 (8.3%) on 0.025 mg/kg and 3 (11.5%) on 0.05 mg/kg. The most common adverse events on teduglutide were fever and vomiting, and the authors judged the safety profile to be similar to what had been seen in adults. Before starting, children have fecal occult blood testing instead of a routine colonoscopy, with colonoscopy or sigmoidoscopy and upper GI endoscopy if there is new or unexplained blood in the stool. The label repeats that testing every year and recommends colonoscopy or sigmoidoscopy for all children after 1 year of treatment and every 5 years after that while treatment continues.
Children with at least a 20% cut in parenteral support at week 24 (%)
All 59 enrolled children completed the 24 week phase 3 trial. Source: Kocoshis and colleagues, JPEN, 2020.
The most common side effects of teduglutide are digestive, which fits a drug that makes the gut grow. In the label's pooled data from 136 adults in two 24 week placebo controlled studies, abdominal pain, nausea, upper respiratory tract infection, abdominal distension, injection site reactions, vomiting, fluid overload and hypersensitivity were all more frequent among the 77 patients on teduglutide than among the 59 on placebo.
Abdominal distension shows the biggest gap, at 20% on teduglutide versus 2% on placebo. A pooled safety analysis of four adult trials by Pape and colleagues in Therapeutic Advances in Gastroenterology in 2020 ([doi.org/10.1177/1756284820905766](https://doi.org/10.1177/1756284820905766)), covering up to 2.5 years and 222 person years of exposure, found that gastrointestinal side effects such as abdominal pain, nausea and distension were most frequent early in treatment and declined over time. Abdominal distension and stoma complications were the events with a significantly raised relative risk compared with placebo.
Common adverse reactions in adults (% of patients)
Pooled from two 24 week placebo controlled studies in 136 adults (Studies 1 and 3). Source: Gattex prescribing information, Table 1, DailyMed, 2025.
The colonoscopy rule exists because a drug that makes intestinal tissue grow could, in principle, make polyps or tumors grow too. The first warning on the Gattex label is acceleration of neoplastic growth, based on the drug's pharmacology and on "tumor findings in the rat and mouse carcinogenicity studies." Intestinal polyps were found during clinical studies, and colorectal, gastric and small intestinal polyps have been reported since approval.
For adults, the label sets a clear schedule. You would need a colonoscopy and upper GI endoscopy with polyp removal within 6 months before starting, a follow up colonoscopy and upper GI endoscopy (or other imaging) at the end of 1 year, and repeat procedures every 5 years or more often if needed, and teduglutide is stopped if a gastrointestinal cancer is diagnosed.
The label lists three other warnings alongside the cancer risk. Intestinal or stomal obstruction calls for pausing the drug, and possible gallbladder, bile duct and pancreatic problems call for blood tests of bilirubin, alkaline phosphatase, lipase and amylase every 6 months. Fluid overload, including congestive heart failure, can happen because the gut is suddenly absorbing more, so IV volumes have to be adjusted as absorption improves.
"A drug that makes intestinal tissue grow could, in principle, make polyps grow too, which is why colonoscopy is built into the label."
Monitoring schedule on the Gattex label
| When | What the label calls for |
|---|---|
| Within 6 months before starting (adults) | Colonoscopy and upper GI endoscopy with removal of polyps |
| Before starting (children) | Fecal occult blood testing, with colonoscopy or sigmoidoscopy and upper GI endoscopy if there is new or unexplained blood in the stool |
| Every year (children) | Repeat fecal occult blood testing |
| Before starting (everyone) | Baseline bilirubin, alkaline phosphatase, lipase and amylase |
| Every 6 months | Repeat bilirubin, alkaline phosphatase, lipase and amylase |
| End of 1 year (adults) | Follow up colonoscopy and upper GI endoscopy or other imaging |
| After 1 year (children) | Colonoscopy or sigmoidoscopy for all pediatric patients |
| Every 5 years after that | Repeat colonoscopy and upper GI endoscopy in adults, or more often as needed, and colonoscopy or sigmoidoscopy in children on continuous treatment |
| If eGFR is below 60 mL/min/1.73 m2 | Dose lowered to 0.025 mg/kg once daily |
| On stopping treatment | Monitor fluid and electrolyte status |
Source: Gattex (teduglutide) prescribing information, DailyMed, accessed October 2026.
Teduglutide can raise the levels of other oral medicines, and this is one of its least known risks. Because the drug increases absorption in general, pills you already take can reach higher levels than before. The label describes one patient taking the benzodiazepine prazepam who experienced "a dramatic deterioration in mental status progressing to coma during the first week" of teduglutide, and it advises monitoring people on oral drugs such as benzodiazepines and lowering their doses if needed.
Kidney function matters as well, since the kidneys clear the drug. For people with an eGFR below 60 mL/min/1.73 m2, the label cuts the dose in half to 0.025 mg/kg once daily.
Longer acting GLP-2 analogs are in development with the aim of replacing the daily injection. Glepaglutide, developed by Zealand Pharma, was tested in the EASE-1 phase 3 trial reported by Jeppesen and colleagues in Gastroenterology in 2025 ([doi.org/10.1053/j.gastro.2024.11.023](https://doi.org/10.1053/j.gastro.2024.11.023)) in 106 patients. Glepaglutide 10 mg twice weekly cut weekly parenteral volume by 5.13 L/wk versus 2.85 L/wk on placebo at 24 weeks, 65.7% versus 38.9% met the clinical response definition, and five patients (14%) on the twice weekly dose were weaned off parenteral support entirely. Once weekly dosing did not separate from placebo on the main endpoints, so dosing frequency still matters even for a long acting molecule.
No head to head trial has compared glepaglutide with teduglutide, which means the two sets of numbers come from different trials with different designs and should not be read as a ranking.
Teduglutide is not a general gut healing peptide, because it has been studied and approved for one narrow and serious condition: short bowel syndrome with dependence on IV support. Its benefits in the trials were measured in liters of IV fluid saved rather than in bloating, leaky gut or everyday digestive comfort, and there are no trials showing benefit in people whose bowel is intact. Its growth effect is exactly why it carries polyp surveillance rules, which would be a poor trade for someone without a serious need. Other gut peptides, such as [larazotide for the gut barrier](https://www.peptidepeppers.com/articles/larazotide-acetate-zonulin-gut-barrier-peptide), target different mechanisms and have their own separate evidence base.
Teduglutide is one of the clearest examples of a peptide doing exactly what its biology predicts. By copying GLP-2, it makes the remaining small intestine grow and absorb more, and in the STEPS trial that translated into 63% of adults cutting their IV volume by more than a fifth, against 30% on placebo, with some patients in the long term extension coming off IV support entirely. The same growth effect explains its costs, which include regular colonoscopies, watchfulness for obstruction and fluid overload, and benefits that fade when the drug stops. If you or someone you love lives with short bowel syndrome, teduglutide is a conversation to have with an intestinal rehabilitation team, and if you are simply curious about gut peptides, it is a useful reminder that real tissue growth comes with real monitoring.
Gattex (teduglutide) prescribing information. DailyMed, U.S. National Library of Medicine. dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=66b69c1e-b25c-44d3-b5ff-1c1de9a516fa
Jeppesen PB, Pertkiewicz M, Messing B, et al. Teduglutide reduces need for parenteral support among patients with short bowel syndrome with intestinal failure. Gastroenterology. 2012. doi.org/10.1053/j.gastro.2012.09.007
Jeppesen PB, Gilroy R, Pertkiewicz M, et al. Randomised placebo controlled trial of teduglutide in reducing parenteral nutrition and/or intravenous fluid requirements in patients with short bowel syndrome. Gut. 2011. doi.org/10.1136/gut.2010.218271
Schwartz LK, O'Keefe SJ, Fujioka K, et al. Long term teduglutide for the treatment of patients with intestinal failure associated with short bowel syndrome. Clinical and Translational Gastroenterology. 2016. doi.org/10.1038/ctg.2015.69
O'Keefe SJ, Jeppesen PB, Gilroy R, et al. Safety and efficacy of teduglutide after 52 weeks of treatment in patients with short bowel intestinal failure. Clinical Gastroenterology and Hepatology. 2013. doi.org/10.1016/j.cgh.2012.12.029
Kocoshis SA, Merritt RJ, Hill S, et al. Safety and efficacy of teduglutide in pediatric patients with intestinal failure due to short bowel syndrome: a 24 week, phase III study. JPEN. 2020. doi.org/10.1002/jpen.1690
Pape UF, Iyer KR, Jeppesen PB, et al. Teduglutide for the treatment of adults with intestinal failure associated with short bowel syndrome: pooled safety data from four clinical trials. Therapeutic Advances in Gastroenterology. 2020. doi.org/10.1177/1756284820905766
Jeppesen PB, Sanguinetti EL, Buchman A, et al. Teduglutide (ALX 0600), a dipeptidyl peptidase IV resistant glucagon like peptide 2 analogue, improves intestinal function in short bowel syndrome patients. Gut. 2005. doi.org/10.1136/gut.2004.061440
Jeppesen PB, Vanuytsel T, Subramanian S, et al. Glepaglutide, a long acting glucagon like peptide 2 analogue, reduces parenteral support in patients with short bowel syndrome: a phase 3 randomized controlled trial. Gastroenterology. 2025. doi.org/10.1053/j.gastro.2024.11.023
Teduglutide (Gattex) is used to treat short bowel syndrome in adults and children 1 year of age and older who depend on parenteral support, meaning IV nutrition or fluids. It helps the remaining small intestine absorb more, so IV support can often be reduced. It is not approved for general digestive complaints.
Teduglutide is a 33 amino acid analog of GLP-2, a gut hormone released by intestinal L cells. It activates GLP-2 receptors in the gut wall, which release growth factors such as IGF-1 and keratinocyte growth factor. That makes villi taller and crypts deeper, which increases the absorbing surface of the intestine.
GLP-1 and GLP-2 are both released by L cells in the intestine, but they do different jobs. GLP-1 mainly affects appetite, insulin release and stomach emptying, which is the basis for semaglutide and tirzepatide. GLP-2 mainly acts on the intestine itself, promoting growth of the lining and better absorption, and that is the signal teduglutide copies.
In the STEPS trial, 63% of adults on teduglutide cut their weekly IV volume by more than 20% at weeks 20 and 24, compared with 30% on placebo. Weekly IV volume fell by a mean of 4.4 L/wk on teduglutide versus 2.3 L/wk on placebo. In the 2 year STEPS-2 extension, 13 patients came off IV support entirely.
The labeled dose of teduglutide for both adults and children is 0.05 mg/kg once daily by subcutaneous injection, rotating between the abdomen, thighs and upper arms. For people with an eGFR below 60 mL/min/1.73 m2, the label lowers the dose to 0.025 mg/kg once daily. A prescriber sets the dose based on body weight.
Gattex promotes intestinal tissue growth, and rodent carcinogenicity studies showed tumor findings, so the label warns of possible acceleration of neoplastic growth. Adults need a colonoscopy and upper GI endoscopy with polyp removal within 6 months before starting, again at 1 year, and then every 5 years. Children start with fecal occult blood testing, repeated every year, and the label recommends colonoscopy or sigmoidoscopy for all children after 1 year of treatment and every 5 years after that.
In the label's placebo controlled data, the most common side effects on teduglutide were abdominal pain (30% vs 22% on placebo), nausea (23% vs 20%), upper respiratory tract infection (21% vs 12%) and abdominal distension (20% vs 2%). A pooled analysis of four trials found that gastrointestinal side effects tend to be more frequent early in treatment and decline over time.
The evidence suggests that the benefits do not last after stopping. In the 2005 Gut pilot study, the improvements in intestinal absorption had reversed after a drug free follow up period. The label also advises monitoring fluid and electrolyte status after discontinuation, since absorption can fall back and IV needs may rise again.
Medical Disclaimer: This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before beginning any peptide protocol.
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