TY - JOUR
T1 - Efficacy of 5-HT 3 antagonists and 5-HT 4 agonists in irritable bowel syndrome
T2 - Systematic review and meta-analysis
AU - Ford, Alexander C.
AU - Brandt, Lawrence J.
AU - Young, Christine
AU - Chey, William D.
AU - Foxx-Orenstein, Amy E.
AU - Moayyedi, Paul
PY - 2009/7
Y1 - 2009/7
N2 - OBJECTIVES:Irritable bowel syndrome (IBS) is a chronic functional disorder. 5-Hydroxytryptamine (5-HT) is a key modulator of gastrointestinal sensorimotor function. Many patients have IBS that can be difficult to treat, which has led to the development of newer agents, such as 5-HT 3 antagonists and 5-HT 4 agonists. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to estimate the efficacy of all available 5-HT agents in IBS.METHODS:MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to June 2008). Trials recruiting adults with IBS in primary, secondary, or tertiary care comparing 5-HT 3 antagonists or 5-HT 4 agonists with placebo were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). The number needed to treat (NNT) was calculated from the reciprocal of the risk difference.RESULTS:The strategic search identified 1,593 citations. A total of 29 RCTs were eligible for inclusion; placebo was compared with 5-HT 3 antagonists in 11 RCTs, with tegaserod in 11, and with mixed 5-HT 3 antagonists/5-HT 4 agonists in 7. The study quality was generally high. The RR of IBS symptoms persisting with 5-HT 3 antagonists vs. placebo was 0.78 (95% CI: 0.71-0.86), with a similar benefit for both alosetron and cilansetron. Tegaserod was also superior to placebo (RR0.85; 95% CI: 0.80-0.90). Renzapride and cisapride had no benefit in IBS.CONCLUSIONS:Alosetron, cilansetron, and tegaserod are all effective in the treatment of IBS. Serious adverse events were rare in the eligible RCTs included in this systematic review.
AB - OBJECTIVES:Irritable bowel syndrome (IBS) is a chronic functional disorder. 5-Hydroxytryptamine (5-HT) is a key modulator of gastrointestinal sensorimotor function. Many patients have IBS that can be difficult to treat, which has led to the development of newer agents, such as 5-HT 3 antagonists and 5-HT 4 agonists. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to estimate the efficacy of all available 5-HT agents in IBS.METHODS:MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to June 2008). Trials recruiting adults with IBS in primary, secondary, or tertiary care comparing 5-HT 3 antagonists or 5-HT 4 agonists with placebo were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). The number needed to treat (NNT) was calculated from the reciprocal of the risk difference.RESULTS:The strategic search identified 1,593 citations. A total of 29 RCTs were eligible for inclusion; placebo was compared with 5-HT 3 antagonists in 11 RCTs, with tegaserod in 11, and with mixed 5-HT 3 antagonists/5-HT 4 agonists in 7. The study quality was generally high. The RR of IBS symptoms persisting with 5-HT 3 antagonists vs. placebo was 0.78 (95% CI: 0.71-0.86), with a similar benefit for both alosetron and cilansetron. Tegaserod was also superior to placebo (RR0.85; 95% CI: 0.80-0.90). Renzapride and cisapride had no benefit in IBS.CONCLUSIONS:Alosetron, cilansetron, and tegaserod are all effective in the treatment of IBS. Serious adverse events were rare in the eligible RCTs included in this systematic review.
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U2 - 10.1038/ajg.2009.223
DO - 10.1038/ajg.2009.223
M3 - Article
C2 - 19471254
AN - SCOPUS:67650455908
SN - 0002-9270
VL - 104
SP - 1831
EP - 1843
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 7
ER -