A network meta-analysis of randomized controlled trials involving the use of secretagogues in the treatment of irritable bowel syndrome with constipation (IBS-C) found that these therapies were superior to placebo with similar efficacy, according to a study published in Gastroenterology.
While several secretagogues have been recently approved by the Food and Drug Administration (FDA), a lack of head-to-head trials led researchers to conduct a systematic review to compare the effectiveness of these agents in patients with IBS-C. They searched various databases and identified 15 randomized controlled involving 8462 patients for inclusion.
Results showed that linaclotide, lubiprostone, plecanatide, and tenapanor (not currently FDA-approved) were all found to be superior to placebo. Linaclotide at a dose of 290mcg once daily was ranked first for efficacy (based on FDA-recommended endpoint for IBS-C trials), while tenapanor 50mg twice daily ranked as most effective for bloating.
With regard to safety, compared with placebo, adverse events were significantly greater with linaclotide 290mcg and 500mcg, and plecanatide 3mg. Plecanatide 6mg was ranked first for safety. Treatment with secretagogues, apart from lubiprostone 8mcg twice daily, was commonly associated with diarrhea, while nausea was more common with lubiprostone treatment.
Among these agents, efficacy was found to be similar for most endpoints (abdominal pain, complete spontaneous bowel movements), however, the authors concluded “data were extracted at the 12-week time point, so the long term relative efficacy of these drugs is unknown.”
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