Systematic review with meta-analysis: lubiprostone efficacy on the treatment of patients with constipation

Abstract

BACKGROUND: Lubiprostone is a type 2 chloride channel activator that has been shown to be efficacious and safe in the treatment for chronic constipation. OBJECTIVE: To systematically review randomized clinical trials (RCTs) assessing efficacy of lubiprostone for patients with chronic idiopathic constipation (CIC), irritable bowel syndrome with predominant constipation (IBS-C) and opioid-induced constipation (OIC). METHODS: Searches were conducted in PubMed, LILACS, Cochrane Collaboration Database, and Centre for Reviews and Dissemination. Lubiprostone RCTs reporting outcomes of spontaneous bowel movements (SBM) and abdominal pain or discomfort were deemed eligible. Meta-analysis was performed calculating risk ratios and 95% confidence intervals, using the Mantel-Haenszel method and random effects model. RESULTS: Searches yielded 109 records representing 93 non-duplicate publications, and 11 RCTs (978 CIC, 1,366 IBS-C, 1,300 OIC, total = 3,644) met inclusion criteria. Qualitative synthesis showed that for CIC patients, lubiprostone is superior to placebo in terms of SBM outcomes. Meta-analysis for CIC was feasible for full responder and SBM within 24h rates, indicating superiority of lubiprostone over placebo. For IBS-C, lubiprostone was significantly superior for all SBM outcomes in follow-ups ranging from 1 week-3 months. In terms of abdominal pain, lubiprostone provided significantly better symptoms relief, particularly after 1 month of treatment. For OIC, lubiprostone was more effective than placebo for both SBM and discomfort measures. CONCLUSION: Our findings demonstrated that lubiprostone is superior to placebo in terms of SBM frequency for CIC, IBS-C and OIC. In terms of abdominal symptoms, the most pronounced effect was seen for abdominal pain in IBS-C patients.

Comparative profiles of lubiprostone, linaclotide, and elobixibat for chronic constipation: a systematic literature review with meta-analysis and number needed to treat/harm

“…In the current study, lubiprostone significantly improved SBM frequency versus placebo (MD: 3.64); however, the results must be interpreted with caution due to the substantial heterogeneity (I 2 = 82%) between trails. An MA conducted by Passos et al also reported similar results, although it was conducted for different outcomes, such as the weekly responder rate and the SBM rate within 24 h [ 48 ]. The most common AE associated with lubiprostone was nausea, followed by abdominal bloating, headache, abdominal pain, diarrhea, and vomiting.…”

Impactos da Síndrome do Intestino Irritável associada à ansiedade e depressão na qualidade de vida da população

“…Em contrapartida, a ingestão de fibras é muito indicada para pacientes que sofrem de constipação, os quais podem se beneficiar em termos de frequência evacuatória, quando associada a ingestão de água e exercícios físicos. Ademais, auxilia em casos de diarreia controlando o peristaltismo intestinal, sendo muito benéfico também o monitoramento dos hábitos alimentares antes de fazer recomendações (Lopes et al, 2019) (Passos et al, 2020).…”