title: Effects of linaclotide in patients with irritable bowel syndrome with constipation or chronic constipation: a meta-analysis.
abstract: OBJECTIVE
  Linaclotide is a minimally absorbed, 14-amino acid peptide used to treat patients with irritable bowel syndrome with constipation (IBS-C) or chronic constipation (CC). We performed a meta-analysis to determine the efficacy of linaclotide, compared with placebo, for patients with IBS-C or CC.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane central register of controlled trials were searched for randomized, placebo-controlled trials examining the effect of linaclotide in adults with IBS-C or CC. Dichotomous results were pooled to yield a relative risk (RR), 95% confidence intervals (CIs), and number needed to treat (NNT).
  
  
  RESULTS
  The search identified 7 trials of linaclotide in patients with IBS-C or CC; 6 were included in the analysis. Two of 3 trials of IBS-C used the end point recommended by the U.S. Food and Drug Administration: an increase from baseline of 1 or more complete spontaneous bowel movement (CSBM)/week and a 30% or more reduction from baseline in the weekly average of daily worst abdominal pain scores for 50% of the treatment weeks. On the basis of this end point, the RR for response to treatment with 290 μg linaclotide, compared with placebo, was 1.95 (95% CI, 1.3-2.9), and the NNT was 7 (95% CI, 5-11). For CC, on the basis of data from 3 trials of patients with CC, the RR for the primary end point (more than 3 CSBMs/week and an increase in 1 or more CSBM/week, for 75% of weeks) was 4.26 for 290 μg linaclotide vs placebo (95% CI, 2.80-6.47), and the NNT was 7 (95% CI, 5-8). Linaclotide also improved stool form and reduced abdominal pain, bloating, and overall symptom severity in patients with IBS-C or CC.
  
  
  CONCLUSIONS
  On the basis of a meta-analysis, linaclotide improves bowel function and reduces abdominal pain and overall severity of IBS-C or CC, compared with placebo.
authors: Beth Israel Deaconess Medical Center, Harvard Medical School Boston, Massachusetts, USA. videlock@gmail.com
authors: Elizabeth J
authors: EJ
authors: Videlock
authors: Vivian
authors: V
authors: Cheng
authors: Filippo
authors: F
authors: Cremonini
mesh_terms: D015746:Abdominal Pain / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000188:drug therapy*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000627:therapeutic use*; D010919:Placebos / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D010455:Peptides; D010919:Placebos; C523483:linaclotide
keywords: BSFS; Bristol Stool Form Scale; CC; CI; CSBM; Clinical Trials; Colon; FDA; Food and Drug Administration; Functional Bowel; IBS-C; ITT; NNT; RCT; RR; Systematic Review; TEAE; chronic constipation; complete spontaneous bowel movement; confidence interval; intention to treat; irritable bowel syndrome with constipation; number needed to treat; randomized controlled trial; relative risk; treatment emergent adverse event