• 对18项涉及9844例患者的随机对照试验进行荟萃分析,表明在干预12周时,阿洛司琼(7项)、雷莫司琼(5项)、利福昔明(2项)和伊卢多啉(4项)用于治疗IBS-D和IBS-M的效果均显著优于安慰剂;
  • 基于FDA建议的IBS临床试验复合终点标准,每天2次1 mg的阿洛司琼效果最好,包括对于粪便硬度的改善;
  • 在改善腹痛方面,每天1次2.5 µg雷莫司琼效果最好;
  • 在不良事件方面,每天3次550 mg利福昔明的安全性最好、引起的便秘也最少。
Gut [IF:23.059]

Efficacy of pharmacological therapies in patients with IBS with diarrhoea or mixed stool pattern: systematic review and network meta-analysis



2019-04-17, Review

Abstract & Authors:展开

Objective : Over half of patients with IBS have either diarrhoea (IBS-D) or a mixed stool pattern (IBS-M). The relative efficacy of licenced pharmacological therapies is unclear in the absence of head-to-head trials. We conducted a network meta-analysis to resolve this uncertainty.
Design : We searched MEDLINE, Embase, Embase Classic, the Cochrane central register of controlled trials, and through January 2019 to identify randomised controlled trials (RCTs) assessing the efficacy of licenced pharmacological therapies (alosetron, eluxadoline, ramosetron and rifaximin) in adults with IBS-D or IBS-M. Trials included in the analysis reported a dichotomous assessment of overall response to therapy, and data were pooled using a random effects model. Efficacy and safety of all pharmacological therapies were reported as a pooled relative risk with 95% CIs to summarise the effect of each comparison tested. Treatments were ranked according to their p score.
Results: We identified 18 eligible RCTs (seven alosetron, five ramosetron, two rifaximin and four eluxadoline), containing 9844 patients. All were superior to placebo for the treatment of IBS-D or IBS-M at 12 weeks, according to the Food and Drug Administration (FDA)-recommended endpoint for trials in IBS. Alosetron 1 mg twice daily was ranked first for efficacy, based on the FDA-recommended composite endpoint of improvement in both abdominal pain and stool consistency, effect on global symptoms of IBS and effect on stool consistency. Ramosetron 2.5µg once daily was ranked first for effect on abdominal pain. Total numbers of adverse events were significantly greater with alosetron 1 mg twice daily and ramosetron 2.5µg once daily, compared with placebo. Rifaximin 550 mg three times daily ranked first for safety. Constipation was significantly more common with all drugs, except rifaximin 550 mg three times daily.
Conclusion: In a network meta-analysis of RCTs of pharmacological therapies for IBS-D and IBS-M, we found all drugs to be superior to placebo, but alosetron and ramosetron appeared to be the most effective.

First Authors:
Christopher J Black

Correspondence Authors:
Alexander C Ford

All Authors:
Christopher J Black,Nicholas E Burr,Michael Camilleri,David L Earnest,Eamonn MM Quigley,Paul Moayyedi,Lesley A Houghton,Alexander C Ford