Qin Di, Tao Qing-Feng, Huang Shi-Le, Chen Min, Zheng Hui
Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Acupuncture department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Front Pharmacol. 2022 Feb 23;13:757969. doi: 10.3389/fphar.2022.757969. eCollection 2022.
Eluxadoline is a newly approved drug for irritable bowel syndrome (IBS), but it has rarely been compared with positive controls. We aimed to compare eluxadoline with antispasmodics in the treatment of IBS. We searched the OVID Medline, Embase, and the Cochrane Central Register of Controlled Trials databases for randomized controlled trials (RCTs) comparing eluxadoline or antispasmodics with placebo. The search was conducted from 1 January 1980, to 1 September 2020, without any language restrictions. The primary efficacy outcome was the relief of abdominal pain, defined by a reduction of pain scores of at least 30% from baseline. The secondary efficacy outcome was the relief of global IBS symptoms, defined by a composite response of a decrease in abdominal pain and improvement in stool consistency on the same day for at least 50% of the days assessed. The data were pooled using a random-effects model. Outcome estimates were pooled by using Risk Ratios (RRs) and P-scores. Forty-two trials with 8,457 participants were included from 45 articles. Compared with placebo, each of drotaverine, pinaverium, alverine combined with simethicone (ACS) and eluxadoline 100 mg was highly effective in the relief of abdominal pain, with drotaverine [RR, 2.71 (95% CI, 1.70 to 4.32), P-score = 0.95] ranking first. Drotaverine, otilonium, cimetropium, pinaverium, and eluxadoline 100 mg had significantly high the relief of global IBS symptomss, for which drotaverine [RR, 2.45 (95% CI, 1.42 to 4.22), P-score = 0.95] was ranked first. No significant difference was found between these interventions. Pinaverium had a significantly higher the relief of global IBS symptoms than eluxadoline [RR, 1.72 (95% CI, 1.33 to 2.21)] on sensitivity analysis. However, no significant difference was found in the number of adverse events between each intervention and the placebo. Our network meta-analysis showed that eluxadoline 100 mg was at least as effective as antispasmodics in relieving abdominal pain in IBS. But eluxadoline had more reported adverse events. Antispasmodics are still the first choice for the treatment of IBS.
埃卢多啉是一种新获批用于治疗肠易激综合征（IBS）的药物，但很少与阳性对照进行比较。我们旨在比较埃卢多啉与抗痉挛药治疗IBS的效果。我们在OVID Medline、Embase和Cochrane对照试验中央注册库数据库中检索了比较埃卢多啉或抗痉挛药与安慰剂的随机对照试验（RCT）。检索时间为1980年1月1日至2020年9月1日，无任何语言限制。主要疗效指标是腹痛缓解，定义为疼痛评分较基线降低至少30%。次要疗效指标是整体IBS症状缓解，定义为在评估的至少50%的天数中，同一天腹痛减轻且大便性状改善的综合反应。数据采用随机效应模型进行汇总。结果估计值采用风险比（RRs）和P值进行汇总。从45篇文章中纳入了42项试验，共8457名参与者。与安慰剂相比，屈他维林、匹维溴铵、西甲硅油铝维林（ACS）和100毫克埃卢多啉在缓解腹痛方面均非常有效，屈他维林[RR，2.71（95%CI，1.70至4.32），P值 = 0.95]排名第一。屈他维林、奥替溴铵、西托溴铵、匹维溴铵和100毫克埃卢多啉在缓解整体IBS症状方面显著更高，其中屈他维林[RR，2.45（95%CI，1.42至4.22），P值 = 0.95]排名第一。这些干预措施之间未发现显著差异。在敏感性分析中，匹维溴铵在缓解整体IBS症状方面显著高于埃卢多啉[RR，1.72（95%CI，1.33至2.21）]。然而，各干预措施与安慰剂之间在不良事件数量上未发现显著差异。我们的网状Meta分析表明，100毫克埃卢多啉在缓解IBS腹痛方面至少与抗痉挛药一样有效。但埃卢多啉报告的不良事件更多。抗痉挛药仍是治疗IBS的首选。
