Systematic review with meta-analysis: lubiprostone efficacy on the treatment of patients with constipation

• Published in: Arquivos de gastroenterologia Vol. 57; no. 4; pp. 498 - 506
• Main Authors: Passos, Maria do Carmo F, Takemoto, Maira Libertad Soligo, Corradino, Gabriel Cyrillo, Guedes, Luciana S
• Format: Journal Article
• Language: English
• Published: Brazil Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE 01.12.2020; Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia (IBEPEGE)
• Subjects: Analgesics, Opioid; Constipation; Constipation - chemically induced; Constipation - drug therapy; Defecation; GASTROENTEROLOGY & HEPATOLOGY; Humans; Irritable bowel syndrome; Irritable Bowel Syndrome - drug therapy; Lubiprostone; Lubiprostone - therapeutic use; Opioid-induced constipation; Treatment Outcome; Opioid-induced constipation; Lubiprostona; Irritable bowel syndrome; Lubiprostone; Constipação induzida por opioides; Síndrome do intestino irritável; Constipation; Constipação intestinal
• ISSN: 0004-2803; 1678-4219; 1678-4219
• DOI: 10.1590/S0004-2803.202000000-83

Lubiprostone is a type 2 chloride channel activator that has been shown to be efficacious and safe in the treatment for chronic constipation. To systematically review randomized clinical trials (RCTs) assessing efficacy of lubiprostone for patients with chronic idiopathic constipation (CIC), irritable bowel syndrome with predominant constipation (IBS-C) and opioid-induced constipation (OIC). Searches were conducted in PubMed, LILACS, Cochrane Collaboration Database, and Centre for Reviews and Dissemination. Lubiprostone RCTs reporting outcomes of spontaneous bowel movements (SBM) and abdominal pain or discomfort were deemed eligible. Meta-analysis was performed calculating risk ratios and 95% confidence intervals, using the Mantel-Haenszel method and random effects model. Searches yielded 109 records representing 93 non-duplicate publications, and 11 RCTs (978 CIC, 1,366 IBS-C, 1,300 OIC, total = 3,644) met inclusion criteria. Qualitative synthesis showed that for CIC patients, lubiprostone is superior to placebo in terms of SBM outcomes. Meta-analysis for CIC was feasible for full responder and SBM within 24h rates, indicating superiority of lubiprostone over placebo. For IBS-C, lubiprostone was significantly superior for all SBM outcomes in follow-ups ranging from 1 week-3 months. In terms of abdominal pain, lubiprostone provided significantly better symptoms relief, particularly after 1 month of treatment. For OIC, lubiprostone was more effective than placebo for both SBM and discomfort measures. Our findings demonstrated that lubiprostone is superior to placebo in terms of SBM frequency for CIC, IBS-C and OIC. In terms of abdominal symptoms, the most pronounced effect was seen for abdominal pain in IBS-C patients.