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Systematic review and network meta‐analysis: efficacy of licensed drugs for abdominal bloating in irritable bowel syndrome with constipation
Author(s) -
Nelson Alfred D.,
Black Christopher J.,
Houghton Lesley A.,
LugoFagundo Nahyr Sofía,
Lacy Brian E.,
Ford Alexander C.
Publication year - 2021
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.16437
Subject(s) - bloating , medicine , irritable bowel syndrome , placebo , lubiprostone , constipation , abdominal pain , gastroenterology , meta analysis , tegaserod , chronic constipation , pathology , alternative medicine
Summary Background Although bloating is a highly prevalent and troublesome symptom in irritable bowel syndrome with constipation (IBS‐C), treatment is empirical with no specific guidelines for its management. Aim To conduct a pairwise and network meta‐analysis, using a frequentist approach, of Food and Drug Administration‐licensed drugs for IBS‐C comparing their efficacy for abdominal bloating as a specific endpoint. Methods We searched the medical literature through December 2020 to identify randomised controlled trials (RCTs) in IBS‐C, with abdominal bloating reported as a dichotomous assessment. Efficacy of each drug was reported as a pooled relative risk (RR) with 95% confidence intervals (CIs) to summarise effect of each comparison tested. Treatments were ranked according to their P ‐score. Results We identified 13 eligible RCTs, containing 10 091 patients. Linaclotide 290 µg o.d., lubiprostone 8 µg b.d., tenapanor 50 mg b.d. and tegaserod 6 mg b.d. were all superior to placebo for abdominal bloating in patients with IBS‐C, in both pairwise and the network meta‐analyses. Linaclotide demonstrated the greatest improvement in abdominal bloating in both pairwise and network meta‐analysis (RR of failure to achieve an improvement in abdominal bloating = 0.78; 95% CI 0.74‐0.83, number needed to treat = 7, P ‐score 0.97). Indirect comparison revealed no significant differences between individual drugs. Conclusions We found all licensed drugs for IBS‐C to be superior to placebo for abdominal bloating. Linaclotide appeared to be the most efficacious at relieving abdominal bloating. Further research is needed to assess long‐term efficacy of these agents and to better understand the precise mechanism of improving bloating.