Factors Associated With Response to Placebo in Patients With Irritable Bowel Syndrome and Constipation

Ballou S1, Beath A2, Kaptchuk TJ3, Hirsch W4, Sommers T4, Nee J4, Iturrino J4, Rangan V4, Singh P4, Jones M2, Lembo A4. Clin Gastroenterol Hepatol. 2018 Apr 12. pii: S1542-3565(18)30345-8. doi: 10.1016/j.cgh.2018.04.009. [Epub ahead of print]

Author information

1 Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: sballou@bidmc.harvard.edu.

2 Department of Psychology, Macquarie University, Sydney, New South Wales, Australia.

3 Program in Placebo Studies, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

4 Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.


BACKGROUND & AIMS: A high proportion of patients with irritable bowel syndrome (IBS) respond to placebo in clinical trials (estimated at about 40%). We aimed to identify factors that contribute to the high placebo response rate using data from a placebo-controlled trials of patients with IBS.

METHODS: We performed a retrospective analysis of 599 women with IBS with constipation who were in the placebo group of a 12-week, randomized, double-blind, phase 3 trial of the experimental medication renzapride. Primary analyses evaluated frequency of abdominal pain in patients who received placebo, defined as ≥30% pain improvement from baseline for ≥6 of the 12 study weeks. We performed backward elimination regression with bootstrapping to identify factors associated with response to placebo.

RESULTS: In the placebo group, 29.0% of the patients had an abdominal pain response. Factors associated with a response to placebo were baseline variation in abdominal pain (odds ratio [OR], 1.71), maximum baseline pain severity (OR, 1.34), and placebo response in study week 2 (OR, 2.23) or week 3 (OR, 3.69). Factors associated with lack of response to placebo were number of baseline complete spontaneous bowel movements (OR, 0.73; P = .019) and final baseline pain ratings (OR, 0.73; P < .001).

CONCLUSIONS: We identified factors associated with a response in abdominal pain to placebo using original data from an IBS clinical trial. Baseline factors associated with the placebo response in women with IBS and constipation included variation in baseline pain symptoms, severity of baseline symptoms, and early improvement of abdominal pain. These findings have significant implications for clinical trial design.

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