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Clinician Article

Comparison of efficacy of pharmacological treatments for chronic idiopathic constipation: a systematic review and network meta-analysis.



  • Nelson AD
  • Camilleri M
  • Chirapongsathorn S
  • Vijayvargiya P
  • Valentin N
  • Shin A, et al.
Gut. 2017 Sep;66(9):1611-1622. doi: 10.1136/gutjnl-2016-311835. Epub 2016 Jun 10. (Review)
PMID: 27287486
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Disciplines
  • Internal Medicine
    Relevance - 6/7
    Newsworthiness - 6/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 5/7
  • Gastroenterology
    Relevance - 6/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 5/7
  • Geriatrics
    Relevance - 5/7
    Newsworthiness - 4/7

Abstract

OBJECTIVE: To compare efficacy of pharmacotherapies for chronic idiopathic constipation (CIC) based on comparisons to placebo using Bayesian network meta-analysis.

DATA SOURCES: We conducted searches (inception to May 2015) of MEDLINE, EMBASE, Scopus and Cochrane Central, as well as original data from authors or drug companies for the medications used for CIC.

STUDY SELECTION: Phase IIB and phase III randomised, placebo-controlled trials (RCT) of =4 weeks' treatment for CIC in adults with Rome II or III criteria for functional constipation; trials included at least one of four end points.

DATA EXTRACTION AND SYNTHESIS: Two investigators independently evaluated all full-text articles that met inclusion criteria and extracted data for primary and secondary end points, risk of bias and quality of evidence.

OUTCOMES: Primary end points were =3 complete spontaneous bowel movements (CSBM)/week and increase over baseline by =1 CSBM/week. Secondary end points were change from baseline (?b) in the number of SBM/week and ?b CSBM/week.

RESULTS: Twenty-one RCTs (9189 patients) met inclusion and end point criteria: 9 prucalopride, 3 lubiprostone, 3 linaclotide, 2 tegaserod, 1 each velusetrag, elobixibat, bisacodyl and sodium picosulphate (NaP). All prespecified end points were unavailable in four polyethylene glycol studies. Bisacodyl, NaP, prucalopride and velusetrag were superior to placebo for the =3 CSBM/week end point. No drug was superior at improving the primary end points on network meta-analysis. Bisacodyl appeared superior to the other drugs for the secondary end point, ?b in number of SBM/week.

CONCLUSIONS: Current drugs for CIC show similar efficacy. Bisacodyl may be superior to prescription medications for ?b in the number of SBM/week in CIC.


Clinical Comments

General Internal Medicine-Primary Care(US)

It is good to have a comparison study of the heavily marketed newer laxatives, and even better to know bisacodyl works well.

General Internal Medicine-Primary Care(US)

Studies of laxative use all show that they seem to work well in comparison with placebo, and biscodyl did as well as newer agents; however, the meta-analysis looked at trials up to only 24 weeks. Longer-term studies are needed, particularly given that stimulants such as biscodyl become less effective with time.

General Internal Medicine-Primary Care(US)

This is a great review for the treatment of chronic idiopathic constipation.

Internal Medicine

Some relatively inexpensive OTC meds are effective.

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