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Review article: an analysis of safety profiles of treatments for diarrhoea‐predominant irritable bowel syndrome
Author(s) -
Lacy Brian E.
Publication year - 2018
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14948
Subject(s) - irritable bowel syndrome , medicine , gastroenterology , diarrhea , intensive care medicine
Summary Background Irritable bowel syndrome ( IBS ) is multifactorial in nature, and a wide range of therapies is available to manage symptoms of this common disorder. Aim To provide an overview of the safety of interventions that may be used to manage patients with diarrhoea‐predominant IBS ( IBS ‐D). Methods Medline and Embase database searches (through 02 May 2018) to identify clinical studies that evaluated treatment safety and/or efficacy in adults with IBS ‐D. Results IBS ‐D treatments include dietary modification, probiotics, serotonin receptor antagonists, opioid receptor agonists and antagonists, nonsystemic antibiotics, bile acid sequestrants, antidepressants, and complementary and alternative therapies. These treatments vary in administration frequency (eg, daily; short‐course therapy) and target various pathophysiologic factors. Safety profiles vary considerably by treatment among IBS ‐D therapies. The number needed to harm (defined as the number of patients treated to encounter an adverse event) was lowest (worse) for antidepressants (8.5) and highest (best) for probiotics (35), and the number needed to harm (defined as the number of patients who discontinued due to an adverse event) was lowest for tricyclic antidepressants (9) and highest for rifaximin (8971). Notable safety concerns with IBS ‐D treatments include pancreatitis with eluxadoline, ischaemic colitis and serious complications of constipation with alosetron, and cardiac adverse events with loperamide and tricyclic antidepressants. Treatment decisions need to account for medication risks and adverse events for each patient. Conclusions Multiple treatment options are now available for patients with IBS ‐D. However, the safety profiles of these agents vary widely by number needed to harm value. Providers should consider both safety and efficacy of a specific intervention when determining how best to manage patients’ IBS ‐D symptoms.