Gut relief revisited: plecanatide in chronic idiopathic constipation and irritable bowel syndrome with constipation - a systematic review and meta-analysis with GRADE assessment.
Menna M Aboelkhier, Ibrahim Suleiman Elnaggar, Nourhan Yasser Elsamahy et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis with GRADE assessment pooled randomized controlled trials comparing plecanatide with placebo in people with chronic idiopathic constipation (CIC) or irritable bowel syndrome with constipation (IBS-C). Plecanatide increased complete spontaneous bowel movements across all reported doses; mean differences were 0.75, 0.92, 0.80, and 1.00, with the greatest improvement at 9 mg (P < 0.00001). Spontaneous bowel movements also improved at 1, 3, and 6 mg. The authors judged 3 mg to offer the best balance of efficacy and safety, while diarrhea was the most frequent adverse event and main reason for discontinuation.
Key findings
- Complete spontaneous bowel movements increased across all reported doses, with mean differences of 0.75, 0.92, 0.80, and 1.00 (P < 0.00001); the greatest improvement was at 9 mg.
- Spontaneous bowel movements improved at 1, 3, and 6 mg, with mean differences of 0.97, 1.50, and 1.58 (P < 0.00001).
- Stool consistency and abdominal pain and bloating improved particularly at 3–6 mg.
- Diarrhea was the most frequent adverse event and the primary reason for treatment discontinuation; other safety outcomes were not significantly affected.
Why it matters
The pooled trial evidence indicates that plecanatide can improve bowel movement outcomes in CIC and IBS-C, while symptom and safety profiles vary across doses. This is relevant when weighing potential benefit against diarrhea, the leading adverse event and reason for stopping treatment. The review identifies 3 mg as the dose with the best balance, but its findings do not establish that one dose is optimal for every patient.
What to keep in mind
The abstract does not report the number of trials or participants, or provide confidence intervals for the pooled estimates, limiting assessment of the precision and breadth of the evidence.