P0627 - Efficacy and Safety of Plecanatide in Treatment of Irritable Bowel Syndrome With Constipation and Chronic Idiopathic Constipation

Shahzaib Ahmed, MBBS¹, Eeman Ahmad, MBBS¹, Umar Akram, ², Iyad Al-bustami, MD, MPH(c)^3
1Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Punjab, Pakistan; ²Allama Iqbal Medical College, Lahore, Punjab, Pakistan; ³Brooklyn Hospital Center, Houston, TX

Introduction: Plecanatide is a guanylate cyclase-C agonist that is indicated for the treatment of irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC).

Methods: We searched through PubMed, Cochrane CENTRAL, Scopus, and ClinicalTrials.gov from inception until June 2024. Trials comparing plecanatide with placebo in patients with IBS-C or CIC were included. Random effects model was used and risk ratios (RRs) and mean differences (MDs) were calculated with their 95% confidence intervals (CIs) using R version 4.4.0. Publication bias was assessed by Luis Furuya-Kanamori index and doi plots.

Results: A total of 7 studies consisting of 6316 participants were included in the analysis. 4349 participants received plecanatide, while 1967 received placebo.



Decrease in abdominal pain in patients with IBS-C was significantly associated with the use of plecanatide (MD = -0.44, 95% CI -0.60; -0.27, P < 0.01).



Change in scores on the Bristol Stool Form Scale (BSFS) was significantly associated with the use of plecanatide in patients with IBS-C (MD = 0.78, 95% CI 0.47; 1.09, P < 0.01) and in patients with CIC (MD = 0.61, 95% CI 0.40; 0.83, P < 0.01).



Change in weekly complete spontaneous bowel movements was not significantly associated with either intervention or control for IBS-C (MD = 0.40, 95% CI -0.25; 1.06, P = 0.19). However, it was significantly associated with plecanatide for CIC (MD = 0.79, 95% CI 0.60; 0.98, P < 0.01), and so was change in weekly spontaneous bowel movements (MD = 1.11, 95% CI 0.77; 1.44, P < 0.01).



Change in straining score was not significant for the pooled data for IBS-C (MD = 0.26, 95% CI -0.18; 0.70, P = 0.20), although it significantly favoured placebo in the 6 mg subgroup (MD = 0.72, 95% CI 0.71; 0.73, P < 0.01). It was significantly associated with the use of plecanatide in patients with CIC (MD = -0.15, 95% CI -0.24; -0.05, P = 0.01).



Occurrence of diarrhoea (RR = 4.11, 95% CI 2.50; 6.77, P < 0.01) and urinary tract infection (RR = 1.70, 95% CI 0.99; 2.91, P = 0.05) was significantly associated with plecanatide, but none of the other adverse effects, including headache, nausea, nasopharyngitis and upper respiratory tract infection exhibited statistical significance.

Discussion: Our results support the efficacy of plecanatide in the treatment of IBS-C and CIC. However, caution must be undertaken while prescribing this drug due to the increased risk of diarrhoea and urinary tract infections.


Disclosures:


Shahzaib Ahmed, MBBS¹, Eeman Ahmad, MBBS¹, Umar Akram, ², Iyad Al-bustami, MD, MPH(c)³. P0627 - Efficacy and Safety of Plecanatide in Treatment of Irritable Bowel Syndrome With Constipation and Chronic Idiopathic Constipation, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.