Secretagogues useful alternatives for irritable Bowel Syndrome with constipation

Intestinal secretagogues are useful and safe therapeutic alternatives for the treatment of irritable bowel syndrome with constipation (IBS-C), according to the results of a network analysis of randomized controlled trials of secretagogues for IBS-C published in the journal Gastroenterology.

A secretagogue is a substance that causes another substance to be secreted. Several secretagogues have been approved treatment of irritable bowel syndrome with constipation (IBS-C) but their relative efficacy is unclear because there have been no head-to-head randomized controlled trials.

Black CJ and associates conducted a conducted a network meta-analysis to compare their efficacies in patients with IBS-C.

The investigators searched MEDLINE, EMBASE, EMBASE Classic, and the Cochrane central register of controlled trials to identify randomized controlled trials assessing the efficacy of secretagogues in adults with IBS-C.

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 the FDA-recommended endpoint for IBS-C trials), while tenapanor 50mg twice daily ranked as most effective for bloating.

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As far as safety was concerned, 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.

“In a network analysis of randomized controlled trials of secretagogues for IBS-C, we found all drugs to be superior to placebo. Efficacy was similar among individual drugs and dosages for most endpoints. However, data were extracted at the 12-week time point, so the long-term relative efficacy of these drugs is unknown,” write the authors.