Nelson Alfred D, Black Christopher J, Houghton Lesley A, Lugo-Fagundo Nahyr Sofía, Lacy Brian E, Ford Alexander C
Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.
Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.
Aliment Pharmacol Ther. 2021 Jul;54(2):98-108. doi: 10.1111/apt.16437. Epub 2021 Jun 11.
Although bloating is a highly prevalent and troublesome symptom in irritable bowel syndrome with constipation (IBS-C), treatment is empirical with no specific guidelines for its management.
To conduct a pairwise and network meta-analysis, using a frequentist approach, of Food and Drug Administration-licensed drugs for IBS-C comparing their efficacy for abdominal bloating as a specific endpoint.
We searched the medical literature through December 2020 to identify randomised controlled trials (RCTs) in IBS-C, with abdominal bloating reported as a dichotomous assessment. Efficacy of each drug was reported as a pooled relative risk (RR) with 95% confidence intervals (CIs) to summarise effect of each comparison tested. Treatments were ranked according to their P-score.
We identified 13 eligible RCTs, containing 10 091 patients. Linaclotide 290 µg o.d., lubiprostone 8 µg b.d., tenapanor 50 mg b.d. and tegaserod 6 mg b.d. were all superior to placebo for abdominal bloating in patients with IBS-C, in both pairwise and the network meta-analyses. Linaclotide demonstrated the greatest improvement in abdominal bloating in both pairwise and network meta-analysis (RR of failure to achieve an improvement in abdominal bloating = 0.78; 95% CI 0.74-0.83, number needed to treat = 7, P-score 0.97). Indirect comparison revealed no significant differences between individual drugs.
We found all licensed drugs for IBS-C to be superior to placebo for abdominal bloating. Linaclotide appeared to be the most efficacious at relieving abdominal bloating. Further research is needed to assess long-term efficacy of these agents and to better understand the precise mechanism of improving bloating.
尽管腹胀是便秘型肠易激综合征（IBS-C）中一种非常普遍且令人困扰的症状，但治疗方法是经验性的，对于其管理没有具体指南。
采用频率论方法，对美国食品药品监督管理局（FDA）批准用于IBS-C的药物进行成对和网状荟萃分析，比较它们作为特定终点对腹部腹胀的疗效。
我们检索了截至2020年12月的医学文献，以确定IBS-C的随机对照试验（RCT），其中腹部腹胀报告为二分法评估。每种药物的疗效报告为合并相对风险（RR）及95%置信区间（CI），以总结每次测试比较的效果。根据P值对治疗进行排序。
我们确定了13项符合条件的RCT，包含10091名患者。在成对和网状荟萃分析中，利那洛肽290μg每日一次、鲁比前列酮8μg每日两次、替那诺尔50mg每日两次和替加色罗6mg每日两次在改善IBS-C患者腹部腹胀方面均优于安慰剂。在成对和网状荟萃分析中，利那洛肽在改善腹部腹胀方面表现出最大改善（腹部腹胀未改善的RR = 0.78；95% CI 0.74 - 0.83，需治疗人数 = 7，P值0.97）。间接比较显示各药物之间无显著差异。
我们发现所有获批用于IBS-C的药物在改善腹部腹胀方面均优于安慰剂。利那洛肽似乎在缓解腹部腹胀方面最有效。需要进一步研究来评估这些药物的长期疗效，并更好地了解改善腹胀的确切机制。
