Patients Often Stop Taking Prescription Meds for IBS With Constipation Within Three Months

By Scott Baltic

March 19, 2020

NEW YORK (Reuters Health) - Many patients with irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC) discontinue prescription medications for these conditions within the first three months, according to a new study.

Among those given lubiprostone, 24% had stopped taking the drug by three months, as had 15% of patients on linaclotide, researchers report in The American Journal of Gastroenterology. The major reasons for discontinuations were intolerance, medication ineffectiveness and loss of insurance coverage.

"Discontinuation of therapy is one of the most important measurable outcomes of treatment in managing chronic diseases," Dr. Eric D. Shah of Dartmouth-Hitchcock Medical Center, in Lebanon, New Hampshire, told Reuters Health by email.

Using data from the University of Michigan Electronic Medical Record spanning 2012 to 2016, Dr. Shah and his colleagues identified 679 patients on lubiprostone (Amitiza) therapy and 933 on linaclotide (Linzess). The average follow-up was 2.5 years.

Overall, patients taking lubiprostone were more likely to stop taking their medication than were those on linaclotide, primarily because of ineffectiveness or loss of insurance coverage.

Just over a third of the lubiprostone users had stopped taking it by six months, and this number rose to 46% by one year. For linaclotide, the rates were 22% and 29%, respectively.

More than half of the patients who discontinued linaclotide did so because of adverse events, mostly diarrhea, whereas this was only the case for between 18% and 26% of lubiprostone users. Lack of efficacy accounted for between 17% and 40% of lubiprostone discontinuations and a quarter of linaclotide discontinuations.

Meanwhile, 43% of the lubiprostone discontinuations by three months were due to lack of insurance coverage, a proportion that fell to 18% between three and 12 months. For linaclotide, non-coverage was responsible for between 8% and 9% of discontinuations.

"Based on these findings, cost appears to influence treatment outcomes for one of the most common diseases in gastroenterology . . . a disease leading to 10-15% of all primary care visits," Dr. Shah said. He added that "we must start to recognize the importance of discussing treatment and healthcare costs as we care for our patients."

Dr. Greg Sayuk, a gastroenterologist at Washington University School of Medicine in St. Louis, Missouri, told Reuters Health that "the eye-opening result of this study was the high percentage of patients who discontinued IBS and CIC therapy within a year of initiating it."

The study, he said by email, "highlights an important focus of discussion with our patients: They will always do best if we identify an effective therapy for CIC or IBS-C and the patient then sticks with it, using it consistently and for the long term as a maintenance regimen."

"A lot of patients are accustomed to using their constipation or IBS-C treatments on an 'as-needed' basis, when symptoms get to be more severe or bothersome," he said. "As chronic conditions, these two disorders are best managed with maintenance therapies taken on a daily basis."

SOURCE: The American Journal of Gastroenterology, online February 4, 2020.