Abstract

Plecanatide Improves Abdominal Bloating and Bowel Symptoms of Irritable Bowel Syndrome with Constipation

Dig Dis Sci. 2024 Apr 9. doi: 10.1007/s10620-024-08330-y. Online ahead of print.

 

Darren M Brenner 1Amol Sharma 2Satish S C Rao 2Adam P Laitman 3Zeev Heimanson 3Christopher Allen 3Gregory S Sayuk 4 5

 
     

Author information

1Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Darren.brenner@nm.org.

2Division of Gastroenterology and Hepatology, Digestive Health Center, Augusta University, Augusta, GA, USA.

3Salix Pharmaceuticals, Bridgewater, NJ, USA.

4Division of Gastroenterology and Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.

5Gastroenterology Section, John Cochran Veterans Affairs Medical Center, St. Louis, MO, USA.

Abstract

Background: Bloating is a bothersome symptom in irritable bowel syndrome with constipation (IBS-C).

Aim: To evaluate plecanatide efficacy in patients with IBS-C stratified by bloating intensity.

Methods: Pooled phase 3 data (2 randomized, controlled IBS-C trials) from adults treated with plecanatide 3 mg or placebo for 12 weeks were analyzed. Patients were stratified post-hoc by baseline bloating severity (11-point scale: mild [≤ 5] and moderate-to-severe [> 5]). Assessments included change from baseline in bloating, abdominal pain, and complete spontaneous bowel movement (CSBM) frequency. Abdominal pain and bloating composite responders were defined as patients with ≥ 30% improvement from baseline in both bloating and abdominal pain at Week 12.

Results: At baseline, 1104/1436 patients with IBS-C (76.9%) reported moderate-to-severe bloating. In the moderate-to-severe bloating subgroup, plecanatide significantly reduced bloating severity versus placebo (least-squares mean change [LSMC]: - 1.7 vs - 1.3; P = 0.002), reduced abdominal pain (- 1.7 vs - 1.3; P = 0.006), and increased CSBM frequency (1.4 vs 0.8; P < 0.0001). In the mild bloating subgroup, significant improvements were observed with plecanatide versus placebo for abdominal pain (LSMC: - 1.3 vs - 1.0; P = 0.046) and CSBM frequency (2.0 vs 1.2; P = 0.003) but not bloating (- 0.9 vs - 0.8; P = 0.28). A significantly greater percentage of patients were abdominal pain and bloating composite responders with plecanatide versus placebo (moderate-to-severe bloating: 33.6% vs 26.8% [P = 0.02]; mild bloating: 38.4% vs 27.2% [P = 0.03]).

Conclusion: Plecanatide treatment improved IBS-C abdominal and bowel symptoms, including in those who present with moderate-to-severe bloating.

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