Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Jacksonville, Florida, USA.
Am J Gastroenterol. 2021 Aug 1;116(8):1601-1611. doi: 10.14309/ajg.0000000000001313.
INTRODUCTION: Tegaserod was the first US Food and Drug Administration-approved drug for irritable bowel syndrome with constipation (IBS-C) in women and was recently reapproved for use. Recognizing that clinical trials were performed almost 20 years ago, we performed an integrated analysis on patient-reported outcomes relevant to current practice including previously unpublished data. METHODS: Data from 4 12-week, randomized, placebo-controlled trials evaluating tegaserod 6 mg b.i.d. in patients with IBS-C were pooled. We analyzed 2 groups: all women (overall population) and women younger than 65 years without a history of cardiovascular ischemic events (indicated population). The primary end point was subjective global assessment of IBS-C symptom relief. Responders rated themselves as "considerably" or "completely" relieved ≥50% of the time or at least "somewhat relieved" 100% of the time over the last 4 weeks. RESULTS: The overall and indicated populations included 2,939 (tegaserod [n = 1,478]; placebo [n = 1,461]) and 2,752 (tegaserod [n = 1,386]; placebo [n = 1,366]) participants, respectively. The pooled odds ratios (95% confidence interval) for clinical response during the last 4 weeks in the overall and indicated populations with tegaserod were 1.37 (1.18, 1.59; P < 0.001) and 1.38 (1.18, 1.61; P < 0.001). In the overall and indicated populations, clinical response rates for tegaserod during the last 4 weeks were 43.3% and 44.1% versus 35.9% and 36.5% with placebo (P < 0.001). Adverse events were similar between groups. No significant cardiovascular events related to tegaserod were observed in patients with ≤1 cardiac risk factor. DISCUSSION: Tegaserod 6 mg b.i.d. reduced IBS-C symptoms in overall and US Food and Drug Administration-indicated populations (women aged <65 years with no history of cardiovascular ischemic events).
简介:替加色罗是第一种获得美国食品药品监督管理局批准用于治疗女性肠易激综合征伴便秘(IBS-C)的药物,最近已重新获准使用。鉴于临床试验是在近 20 年前进行的,我们针对当前实践相关的患者报告结局进行了综合分析,包括以前未发表的数据。
方法:我们对 4 项为期 12 周、随机、安慰剂对照的替加色罗 6mg 每日 2 次治疗 IBS-C 患者的临床试验数据进行了汇总分析。我们分析了 2 组人群:所有女性(总体人群)和年龄<65 岁且无心血管缺血事件史的女性(适应证人群)。主要终点为 IBS-C 症状缓解的主观整体评估。应答者自我评估在过去 4 周内有≥50%的时间“明显”或“完全”缓解,或有 100%的时间“有些”缓解。
结果:总体人群和适应证人群分别包括 2939 例(替加色罗组[n=1478],安慰剂组[n=1461])和 2752 例(替加色罗组[n=1386],安慰剂组[n=1366])患者。在总体人群和适应证人群中,替加色罗在最后 4 周的临床应答比值比(95%置信区间)分别为 1.37(1.18,1.59;P<0.001)和 1.38(1.18,1.61;P<0.001)。在总体人群和适应证人群中,替加色罗在最后 4 周的临床应答率分别为 43.3%和 44.1%,安慰剂组分别为 35.9%和 36.5%(P<0.001)。两组不良反应相似。在仅有 1 项心脏危险因素的患者中,未观察到与替加色罗相关的重大心血管事件。
讨论:替加色罗 6mg 每日 2 次可减轻总体人群和美国食品药品监督管理局适应证人群(年龄<65 岁且无心血管缺血事件史的女性)的 IBS-C 症状。
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