No Clear Winner Among Remedies for Chronic Constipation

By David Douglas

June 24, 2016

NEW YORK (Reuters Health) - No currently used drug shows clear superiority over another in prompting spontaneous bowel movements in patients with chronic idiopathic constipation, according to a new network meta-analysis.

As Dr. Michael Camilleri told Reuters Health by email, "There are several efficacious treatments that can be prescribed for chronic idiopathic constipation, and optimal choice may depend on individual characteristics of the patient."

"The network meta-analysis approach," he added, "provides an opportunity to assess relative efficacy of different medications when they have not been compared head-to-head."

For their study, online June 10 in Gut, Dr. Camilleri and colleagues at the Mayo Clinic in Rochester, Minnesota, note that they examined data from 21 randomized controlled trials involving nearly 9,200 patients. Drugs employed included bisacodyl, sodium picosulphate, prucalopride, and velusetrag.

All of these agents were superior to placebo in achieving the primary endpoint of prompting three or more spontaneous bowel movements per week.

There was an indication that bisacodyl might be more effective than others in improvement of spontaneous bowel movements over baseline. However, "There is only one bisacodyl trial with only four weeks of treatment compared with other drugs, which provided treatment for 12 or 24 weeks," the researchers point out. Moreover, the use of the agent may have adverse effects.

Thus, concluded Dr. Camilleri, "Even this sophisticated analysis needs to be interpreted with caution, and the overall assessment demonstrates that, for the primary endpoints of interest used by regulatory bodies, there is no evidence of superiority among the different drugs, although all show significant efficacy compared to placebo."

Gastroenterologist Dr. Anthony J. Lembo, of Beth Israel Deaconess Medical Center, Boston, who was not involved in the research, told Reuters Health by email, "The key message of this study is that the current pharmacological treatments have similar efficacy for treating constipation."

"Direct head-to-head comparisons, which are currently not available, would be needed to determine if there is a significant advantage of one treatment versus another," he added. "Bisacodyl was superior in increasing bowel movements. However, this was at the expense of significant side effects, including diarrhea and abdominal pain, limiting its use in many patients."


Gut 2016.