Efficacy and Safety of Intestinal Secretagogues for Chronic Constipation: A Systematic Review and Meta-Analysis

Lasa, Juan S.; Altamirano, Maria J.; Bracho, Luis Florez; Paz, Silvina; Zubiaurre, Ignacio

doi:10.1590/s0004-2803.201800000-41

Cited by 7 publications

(5 citation statements)

References 28 publications

(38 reference statements)

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“…The literature search yielded 766 records. In total, 31 MAs 9–39 met the eligibility criteria (Figure 1). MAs of head-to-head trials were unavailable, hence we included network MAs presenting evidence from indirect comparisons.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of biologic agents and tofacitinib in moderate‐to‐severe ulcerative colitis: A systematic overview of meta‐analyses

et al. 2019

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Background: Ulcerative colitis (UC) is an inflammatory disease of the colon and rectum. Treatment options include biologics and tofacitinib. Objectives: We aim to summarize the evidence on efficacy and safety of biologics and tofacitinib in moderate-to-severe UC. Methods: PubMed, Embase, Scopus, and the Cochrane Library were systematically searched to identify meta-analyses of randomized controlled trials assessing adalimumab, golimumab, infliximab, vedolizumab, and tofacitinib in UC. Efficacy outcomes included induction and maintenance of clinical response, clinical remission and mucosal healing. Safety outcomes included adverse events and serious adverse events. Results: The overview involved 31 meta-analyses. All four biologics and tofacitinib were superior to placebo regarding efficacy. Indirect comparisons suggested that infliximab may be better than adalimumab and golimumab to induce clinical response and mucosal healing. Safety analyses indicated no increased rates of adverse events, except for infliximab. Conclusions: Biologics and tofacitinib are efficacious and safe for treating UC. These findings can support clinical decisionmaking.

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Section: Resultsmentioning

confidence: 99%

Efficacy and safety of biologic agents and tofacitinib in moderate‐to‐severe ulcerative colitis: A systematic overview of meta‐analyses

et al. 2019

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“…Superiority of tenapanor versus placebo has been established in three double-blind, placebo-controlled trials and reviewed in multiple systematic reviews and meta-analyses [15,[70][71][72][73]. In the pivotal trials T3MPO-1 and T3MPO-2, tenapanor demonstrated statistically significant improvement over placebo in the FDA-guidance composite endpoint, as well as in each of the individual symptoms, at the 6/12, 9/12, and 13/26-week time points (except CSBMs at the 6/12 time point in T3MPO-1) [9,69,71,72].…”

Section: Tenapanormentioning

confidence: 99%

Diarrhea-Predominant and Constipation-Predominant Irritable Bowel Syndrome: Current Prescription Drug Treatment Options

Wechsler

Shah

2021

Drugs

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Irritable bowel syndrome (IBS) is a heterogenous disease with a variety of therapeutic options, including eight prescription drugs approved for use in IBS in the USA. Choosing among the myriad treatment options requires attention to patient preferences both on clinical outcomes and costs associated with treatment. We performed a narrative review of the literature to summarize these important determinants of treatment choice including: labeled indications; clinical profiles of efficacy, safety, and tolerability of prescription drugs; and cost-effectiveness for diarrhea-predominant IBS drugs (IBS-D: alosetron, eluxadoline, and rifaximin) and constipation-predominant IBS drugs (IBS-C: linaclotide, lubiprostone, plecanatide, tegaserod, and tenapanor). We then review the standard model of shared decision-making aimed at guiding an informed, patient-centered discussion to integrate comparative clinical and cost outcomes toward choosing an IBS treatment in practice.

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“…Trials studying different doses of a single treatment (e.g., 16,32, and 48 μg lubiprostone; 1, 2, and 4 mg prucalopride; and 0.5 and 1 mg alvimopan) or non-approved treatment dosages (e.g., linaclotide 1000 μg) were included in the treatment network. In general, different doses of a single treatment were considered as separate treatment modalities in the network.…”

Section: Network Meta-analysismentioning

confidence: 99%

“…In clinical practice, selection of the most appropriate therapy for CC is challenging due to the lack of direct comparisons between the available constipation drugs. Most published trials on constipation treatments are placebo-controlled studies, limiting the ability to compare active treatments [15,16]. A valid statistical estimate of the comparative efficacy of different treatment modalities can be achieved using a network meta-analysis (NMA) that combines direct head-to-head evidence and indirect comparative evidence [17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Comparative Efficacy of Linaclotide Versus Other Oral Constipation Treatments in Chronic Constipation: a Network Meta-analysis

Okumura

Tang²,

Iwasaki³

et al. 2020

SN Compr. Clin. Med.

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This systematic literature review and network meta-analysis (NMA) indirectly compared the Japanese standard dose of linaclotide 500 μg with other oral chronic constipation (CC) treatments. PubMed, Cochrane-CENTRAL, Ichushi-Web, and ClinicalTrials.gov were systematically searched for eligible randomized controlled trials of 43 oral drugs approved globally for CC, including irritable bowel syndrome with constipation (IBS-C) and opioid-induced constipation (OIC). The mean difference (95% credible interval) in change from baseline in weekly number of spontaneous bowel movements (SBM) was compared between linaclotide 500 μg (unapproved in OIC) and other treatments using Bayesian methodology. Fifty-two publications (54 trials) involving 47 treatments (16 drugs, different doses of the same drug treated as different treatments) were included in the NMA. Despite including various drugs/doses, for the mean difference in weekly SBM change, linaclotide 500 μg was statistically significantly more efficacious than other drugs/doses (vs 500 μg linaclotide) including the following: placebo (− 1.907; − 2.568, − 1.237); lubiprostone 16 μg (− 2.090; − 3.226, − 0.968); methylnaltrexone 150 mg (− 1.807; − 3.126, − 0.491), 300 mg (− 1.411; − 2.722, − 0.096), and 450 mg (− 1.405; − 2.708, − 0.097); naloxegol 5 mg (− 2.074; − 4.001, − 0.131) and 12.5 mg (− 1.329; − 2.347, − 0.318); and tegaserod 4 mg (− 1.133; − 2.059, − 0.207) and 12 mg (− 1.024; − 1.822, −0.228), and statistically significantly less effective than linaclotide 600 μg non-approved dose (1.159; 0.123, 2.199) and bisacodyl 10 mg (2.979; 1.723, 4.233). These findings provide relative efficacy data for linaclotide 500 μg vs other constipation drugs/doses regarding improving weekly SBM in CC and IBS-C and may inform clinical decision-making for constipation treatments.

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Efficacy and Safety of Intestinal Secretagogues for Chronic Constipation: A Systematic Review and Meta-Analysis

Abstract: Intestinal secretagogues are useful and safe therapeutic alternatives for the treatment of constipation-related syndromes.

Cited by 7 publications

References 28 publications

Efficacy and safety of biologic agents and tofacitinib in moderate‐to‐severe ulcerative colitis: A systematic overview of meta‐analyses

Efficacy and safety of biologic agents and tofacitinib in moderate‐to‐severe ulcerative colitis: A systematic overview of meta‐analyses

Diarrhea-Predominant and Constipation-Predominant Irritable Bowel Syndrome: Current Prescription Drug Treatment Options

Comparative Efficacy of Linaclotide Versus Other Oral Constipation Treatments in Chronic Constipation: a Network Meta-analysis

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