POEMs

Patient-Oriented Evidence That Matters

Drugs for Chronic Idiopathic Constipation Are Similarly Effective

 

Am Fam Physician. 2018 Jun 15;97(12):819-820.

Clinical Question

What is the most effective drug treatment for chronic idiopathic constipation?

Bottom Line

If nondrug measures are unsuccessful for chronic idiopathic constipation, the choice of a pharmacologic agent should be based on cost, tolerability, and long-term adherence rather than efficacy, because the efficacy is similar among drugs and drug classes. Bisacodyl (Dulcolax) increases the number of spontaneous bowel movements more than other drugs. (Level of Evidence = 1a)

Synopsis

There are many treatment options for patients with chronic idiopathic constipa -tion, including osmotic and stimulant laxatives; 5-hydroxytryptamine receptor 4 agonists, such as prucalopride, tegaserod, and velusetrag (none of which are currently available in the United States); linaclotide (Linzess); lubipros-tone (Amitiza); and elobixibat (not approved in the United States). This study was a network meta-analysis that performed direct comparisons (where possible) and indirect comparisons of trials of different drugs compared with a common control drug or placebo. This was a methodologically rigorous meta-analysis, with a thorough search of multiple databases, data abstraction by two independent investigators, and careful assessment of study quality. The authors identified 21 studies with a total of 9,189 patients that compared nine different drugs with placebo. The primary outcomes that defined a clinical response were having at least three more complete spontaneous bowel movements (CSBMs) per week or an increase from baseline of one or more CSBMs per week. Most studies were set in the United States or Europe, were adequately powered, and enrolled patients with a mean age of late 40s or 50s. Most studies defined constipation as less than two or three CSBMs per week. The overall quality of most included studies was judged to be moderate or high.

The results for several drugs (including bisacodyl, tegaserod, linaclotide, and sodium picosulfate) came from a single trial. In direct comparisons

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see https://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.

 

 

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