Authors: Shah ED et al. Summary: This was a systematic review and meta-analysis of eight trials investigating linaclotide and seven investigating plecanatide in a total of 10,369 patients with chronic idiopathic constipation or IBS with constipation. Efficacy according to US FDA-approved composite responder endpoints was seen for chronic idiopathic constipation with linaclotide 72μg and 145μg (respective ORs 3.11 [95% CI 1.81–5.34] and 3.25 [2.15–4.91]) and plecanatide 3mg (1.99 [1.57–2.51]), and for IBS with constipation with linaclotide 290μg (2.43 [1.48–3.98]) and plecanatide 3mg and 6mg (1.87 [1.47–2.38] and 1.92 [1.48–2.48]). When treating chronic idiopathic constipation, the likelihood of diarrhoea was increased with linaclotide 72μg and 145μg (respective ORs 3.07 [95% CI 1.97–4.77] and 3.70 [2.69–5.10]) and plecanatide 3mg (3.8 [1.83–8.12]) versus placebo, and when treating IBS with constipation, the likelihood was increased with linaclotide 290μg (8.02 [5.20–12.37]) and plecanatide 3mg and 6mg (5.55 [1.62–19.00] and 4.13 [1.57–10.83]). No significant differences were seen between therapies for efficacy, diarrhoea or diarrhoea-related study withdrawals.
Comment: Although not funded by the PBS, linaclotide and plecanatide are guanylate cyclase-C agonists for the treatment of chronic idiopathic constipation and IBS with constipation. Now broadly used internationally, this useful meta-analysis pooled studies to establish efficacy and tolerability in IBS with constipation and chronic idiopathic constipation. The meta-analysis established that both agents are similarly efficacious and tolerated for the two indications.
Reference: Am J Gastroenterol 2018;113:329–38