Multicenter, 4-week, double-blind, randomized, placebo-controlled trial of lubiprostone, a locally-acting type-2 chloride channel activator, in patients with chronic constipation.
OBJECTIVE
To assess the efficacy and safety of lubiprostone in adults with chronic constipation.


METHODS
This multicenter, parallel-group, double-blind controlled trial enrolled 242 patients with constipation and randomized them to receive oral lubiprostone 24 mcg or placebo twice daily for 4 wk. The primary efficacy end point was the number of spontaneous bowel movements (SBMs; those occurring without use of constipation relieving medications) after 1 wk of double-blind treatment. Other evaluations included SBMs at weeks 2, 3, and 4; bowel movement (BM) characteristics (i.e., consistency and straining); constipation severity; abdominal bloating/discomfort; global treatment effectiveness ratings; and safety assessments.


RESULTS
The 120 lubiprostone-treated patients reported a greater mean number of SBMs at week 1 compared with the 122 placebo-treated patients (5.69 vs 3.46, P= 0.0001), with a greater frequency of SBMs also reported at weeks 2, 3, and 4 (P<or= 0.002). Within 24 h of the first dose of study drug, 56.7% of those given lubiprostone reported a SBM compared with 36.9% of those given placebo (P= 0.0024); within 48 h, 80% and 60.7% of these patients reported a SBM (P= 0.0013), respectively. Stool consistency, straining, and constipation severity, as well as patient-reported assessments of treatment effectiveness, were significantly improved with lubiprostone compared with placebo at all weeks (P<or= 0.0003). The two most common treatment-related adverse events were nausea (31.7%) and headache (11.7%).


CONCLUSIONS
In patients with chronic constipation, treatment with lubiprostone produces a BM in the majority of individuals within 24-48 h of initial dosing and improves the frequency as well as other characteristics associated with BMs with short-term (i.e., 4 wk) treatment. The most commonly reported adverse event was mild to moderate nausea, which resulted in treatment discontinuation in 5% of treated patients.
Johanson
John F
JF
University of Illinois College of Medicine, Rockford, Illinois, USA.
Morton
Dan
D
Geenen
Joseph
J
Ueno
Ryuji
R
D000527:Alprostadil / Q000008:administration & dosage / Q000031:analogs & derivatives*; D065101:Chloride Channel Agonists; D002908:Chronic Disease; D003248:Constipation / Q000188:drug therapy* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005227:Fatty Acids / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000068238:Lubiprostone; D008297:Male; D008875:Middle Aged; D010528:Peristalsis / Q000187:drug effects; D012720:Severity of Illness Index; D016896:Treatment Outcome
D065101:Chloride Channel Agonists; D005227:Fatty Acids; D000068238:Lubiprostone; D000527:Alprostadil