Dr Alfred Nelson and colleagues compared the efficacy of pharmacotherapies for chronic idiopathic constipation based on comparisons to placebo using Bayesian network meta-analysis.
The researchers conducted searches of MEDLINE, EMBASE, Scopus and Cochrane Central, as well as original data from authors or drug companies for the medications used for chronic idiopathic constipation.
The team evluated Phase IIB and phase III randomized, placebo-controlled trials of 4 weeks' or more treatment for chronic idiopathic constipation in adults with Rome II or III criteria for functional constipation.
Trials included at least 1 of 4 end points.
There were 2 investigators that independently evaluated all full-text articles that met inclusion criteria, and extracted data for primary and secondary end points, risk of bias and quality of evidence.
Primary end points were 3 or more complete spontaneous bowel movements per week and increase over baseline by 1 complete spontaneous bowel movements per week or more.
|No drug was superior at improving the primary end points on network meta-analysis|
Secondary end points were change from baseline in the number of SBM/week and change from baseline complete spontaneous bowel movements per week.
The research team noted that 21 randomized controlled trials met inclusion and end point criteria.
Of these, 9 investigated prucalopride, 3 lubiprostone, 3 linaclotide, 2 tegaserod, 1 each velusetrag, elobixibat, bisacodyl and sodium picosulphate.
All prespecified end points were unavailable in four polyethylene glycol studies.
Bisacodyl, sodium picosulphate, prucalopride and velusetrag were superior to placebo for the 3 complete spontaneous bowel movements per week or more per end point.
The team found that no drug was superior at improving the primary end points on network meta-analysis.
Bisacodyl appeared superior to the other drugs for the secondary end point, change from baseline in number of spontaneous bowel movements per week.
Dr Nelson's team concludes, "Current drugs for chronic idiopathic constipation show similar efficacy."
"Bisacodyl may be superior to prescription medications for change from baseline in the number of spontaneous bowel movements per week in chronic idiopathic constipation."