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Not medical advice. The Atlas is not a substitute for a clinician who can examine you.

GLP-2 / Teduglutide

Gattex · GLP-2 Receptor Agonist

Evidence grade 3 of 5, Mixed. Read how the Atlas grades evidence.

Two very different things share this entry and must be graded apart. The synthetic DPP-4-resistant analog TEDUGLUTIDE (Gattex in the US, Revestive in the EU) is FDA-approved (adults 2012, children 1 year and older 2019) for short bowel syndrome with intestinal failure, supported by the pivotal 24-week placebo-controlled STEPS trial (a clinically meaningful reduction in parenteral support was reached in about 63 percent of teduglutide patients versus 30 percent on placebo) plus the STEPS-2 and STEPS-3 long-term extensions, so it earns grade 4-5 for that one narrow indication. Native GLP-2 sold gray-market for leaky gut, IBD or general gut healing is a different case: it is a 33-amino-acid hormone with a roughly 7-minute half-life, has no human RCTs for those uses, is not an approved drug, and is marketed as a research chemical, so that use is grade 0-1. The blended entry-level grade is set to 3 to reflect the honest split rather than the current inflated 5.

FDA
Teduglutide FDA Approved (Gattex, adults 2012; children 1yr+ 2019); native GLP-2 not approved
WADA
Not prohibited

Reference only. Not medical advice.

What can go wrong

Teduglutide is trophic to intestinal tissue and carries a FDA REMS requiring baseline and periodic colonoscopy with polyp removal; reported risks include colorectal and GI polyps, intestinal obstruction, and gallbladder, biliary and pancreatic disease. Native GLP-2 sold for gut healing is an unapproved research chemical with no human trials.

Talk to a clinician before taking this, particularly if you have any history of cancer. The Atlas can tell you what has been studied about GLP-2 / Teduglutide. It cannot tell you how it would interact with your body, your history, or anything else you are taking, and nothing on this page is a reason to start.

GLP-2 is an intestinotrophic gut hormone. Its DPP-4-resistant analog teduglutide (Gattex/Revestive) is FDA-approved for short bowel syndrome and reduces the need for intravenous nutrition, but native GLP-2 sold for leaky gut and IBD is an unapproved research chemical with no human trials.

What people take it for

These are the reasons people give for taking it. They are not effects it has been shown to have.

  • Short bowel syndrome (approved)
  • Gut mucosal repair
Short bowel syndrome in adults
FDA-approved in 2012 for adults with short bowel syndrome who depend on intravenous nutrition or fluids, reducing or sometimes eliminating that dependence by improving intestinal absorption.
Short bowel syndrome in children
Approved for pediatric patients aged one and above with short bowel syndrome dependent on intravenous support.

How it is supposed to work

Teduglutide is an analog of GLP-2, a gut hormone that promotes growth and absorption in the intestinal lining. By stimulating the intestine to grow and absorb more, it reduces the need for intravenous nutrition in people whose bowel cannot absorb enough on its own. It is the intestinal cousin of the far more famous GLP-1.

Teduglutide is a recombinant 33-amino-acid analog of human glucagon-like peptide-2, a hormone secreted by intestinal cells. It is GLP-1’s close relative, both cut from the same parent protein, and a single amino-acid change protects it from the enzyme that would otherwise break it down in minutes, extending its action to a usable couple of hours. It is given by daily injection and sold as Gattex and Revestive.

Type
Recombinant GLP-2 analog
Relation
GLP-1’s sibling
Action
Grows gut absorptive surface
Use
Short bowel syndrome
Dosing
Daily injection
Approved
2012

GLP-1’s Obscure Sibling, That Regrows The Gut

Almost everyone has heard of GLP-1, the hormone behind the blockbuster weight-loss drugs. Far fewer know it has a sibling, GLP-2, cut from the same parent protein and released by the same gut cells, whose job is not metabolism but maintaining and growing the intestinal lining. Teduglutide is the drug built from it, and it is a genuinely transformative one for a small, severely affected group. Short bowel syndrome leaves people unable to absorb enough nutrition through what remains of their intestine, tethering them to hours of intravenous feeding with all its risks. By coaxing the remaining gut to grow more absorptive surface, teduglutide lets many of them cut back that intravenous support, and some come off it entirely, the first drug to treat the cause rather than just supply the missing nutrition. The honest caveat follows from how it works: a drug that tells the gut to grow demands vigilance about unwanted growth, so patients undergo periodic colonoscopy to watch for polyps, alongside monitoring for bowel obstruction and fluid and gallbladder issues. It is also an expensive orphan drug given by daily injection.

Safety in detail

Do not conflate the two. Teduglutide is a labeled prescription drug for a rare condition (short bowel syndrome) administered under specialist supervision with a REMS-mandated colonoscopy before starting, again at one year, then roughly every five years, because postmarketing colorectal, gastric and small-intestinal polyp cases have been reported. Gray-market native GLP-2 marketed for leaky gut or IBD has no FDA approval, no human RCT support, and no such monitoring, and its intestinotrophic action is the same reason polyp and neoplasia signals warrant caution.

  • Because it promotes intestinal growth, it carries a risk of polyps and a theoretical risk of intestinal cancer, so colonoscopy monitoring is required.
  • Gastrointestinal effects, fluid overload and injection-site reactions occur.
  • It is a specialist therapy for a serious rare condition, used under close supervision.

Children and teenagers

Teduglutide has a genuine, important pediatric use: it is approved for children from age one with short bowel syndrome dependent on intravenous support, a serious intestinal-failure population. The colonoscopy surveillance and other monitoring apply, and it is a legitimate, specialist-managed pediatric orphan drug that can meaningfully reduce a child’s dependence on intravenous nutrition.

What people get wrong

Nothing recorded here yet. There is almost certainly something people get wrong about this one, and the blank space means we have not written it down, not that the record is clean.

Who profits, and who pushes back

Nobody is named here yet, because we have not done that work on this entry. Read that as unfinished. Somebody almost certainly sells this, and somebody almost certainly disputes it. Assume both until we have checked.

Teduglutide’s economy is a legitimate orphan-drug one: a high-priced daily injection for a rare, severe disease, with a small population but high per-patient value, now extended by a pipeline of longer-acting GLP-2 analogs. Its commercial story is standard rare-disease medicine rather than consumer marketing.

How we got here

Native GLP-2 is a 33-amino-acid gut hormone that drives intestinal mucosal growth but is degraded within minutes by dipeptidyl peptidase-4 (DPP-4), giving it a half-life of roughly 7 minutes. Teduglutide (Gattex in the US, Revestive in the EU) is the DPP-4-resistant analog, substituting glycine for alanine at position two, which extends its half-life and made it the first approved GLP-2 therapy for short bowel syndrome in 2012. Longer-acting next-generation analogs apraglutide and glepaglutide extend dosing toward once-weekly, while native GLP-2 itself circulates in gray-market research-peptide channels.

The gut-growing effect of the glucagon peptide family was first noticed in 1971 in a patient whose glucagon-secreting tumor had enlarged the small intestine, leading to the identification of GLP-2 as an intestinal growth factor. Teduglutide was developed as a degradation-resistant GLP-2 analog, received orphan designation around 2000, and was approved by the FDA as Gattex and in Europe as Revestive in 2012, with pediatric use following. Longer-acting analogs like glepaglutide and apraglutide have since advanced in trials.

  1. 1971A glucagon-secreting tumor reveals the gut-growing effect of the peptide family.
  2. 2000Teduglutide receives orphan-drug designation.
  3. 2012The FDA approves Gattex and Europe approves Revestive for adults.
  4. 2016European approval is extended to children from age one.
  5. 2020sLonger-acting GLP-2 analogs advance in Phase 3.

The numbers behind the grade

Type
GLP-2 analog
Brand
Gattex / Revestive
Approved
2012
Use
Short bowel syndrome
Monitoring
Colonoscopy
Class
Incretin (GLP-2)

The people taking it

Little known to the public but clinically important, teduglutide is the approved GLP-2 analog, a reminder that the incretin family extends beyond the blockbuster GLP-1 drugs.

Teduglutide’s users are people with short bowel syndrome, adults and children from age one, who depend on intravenous nutrition or fluids, a small and severely affected rare-disease population whose intestinal loss may stem from Crohn’s disease, surgery, loss of blood supply, trauma or birth conditions. They are managed by gastroenterology and nutrition specialists.

Used for short bowel syndrome to reduce dependence on intravenous nutrition, under specialist care. A genuine approved drug for a serious rare disease.

Set against the alternatives

The defining comparison is to GLP-1, its famous sibling: both come from the same parent protein and the same gut cells and are protected by the same kind of modification, but GLP-1 became a metabolic blockbuster while GLP-2 remained a niche intestinal-growth drug, the other GLP. Against the next-generation GLP-2 analogs like glepaglutide and apraglutide, which are longer-acting and dosed weekly and have shown some patients reaching full independence from intravenous support, teduglutide is the established first option. And against parenteral nutrition, the intravenous feeding that is the standard support in short bowel syndrome, it treats the absorption problem itself rather than just supplying nutrition. Its strength is being genuinely disease-modifying; its limits are growth-related monitoring and cost.

What we do not know

  • How to identify which short-bowel patients benefit most.
  • How to balance its growth-promoting benefit against the need for cancer surveillance.
  • Whether GLP-2 biology has other legitimate uses.

What could change

Weekly analogsLonger-acting GLP-2 analogs like glepaglutide and apraglutide aim for weekly dosing.Full independenceNewer agents have brought some patients off intravenous support entirely.Next-generation formatsFusion proteins and other formats are in development.Broader intestinal failureResearch explores wider intestinal-failure applications.

The market for this

What follows describes how this is bought and sold. It is not a buying guide and it is not an endorsement of any seller.

Available only by specialist prescription as an approved biologic, with required monitoring. It is a regulated medical therapy, not a consumer or gray-market peptide.

Teduglutide is a high-priced orphan drug for a rare disease, very expensive, typically accessed through specialty insurance coverage and patient-assistance programs.

Manufactured as an approved specialty biologic under full regulation; a controlled, traceable supply.

Branded orphan drugIt is supplied as a branded daily injection for a rare disease.Specialty pharmacyIt moves through rare-disease and specialty channels.Small populationSupply serves a small, severely affected patient group.

What this entry does not yet cover

What follows is unfinished work on our side, not a finding about GLP-2 / Teduglutide.

Nothing outstanding on this one.

Sources

The studies that matter

  • STEPS trials2010s

    Pivotal trials in short bowel syndrome showed teduglutide reduced patients’ dependence on parenteral (intravenous) nutrition, the basis for approval.

  • Long-term extension data2010s-2020s

    Follow-up studies supported sustained reductions in parenteral support for responders.