Poster 1724 Patients’ Use of and Experience With Medications for Management of Symptoms of Chronic Constipation
Author Insight from William Spalding, Director, Health Economics and Outcomes Research, Ironwood Pharmaceuticals
What’s new here and important for clinicians?
Many older medications, such as polyethylene glycol (PEG) and stimulant laxatives have long been and continue to be prescribed as first-line therapy after lifestyle and dietary modifications have failed for chronic idiopathic constipation (CIC). Yet our study indicates that the majority of patients are generally not satisfied with these treatments.
Our 2013 Phase 3b study screened nearly 1,500 patients who were enrolling in a clinical trial for CIC, and found that approximately 70% had taken at least one class of older medications (polyethylene glycol [PEG]), psyllium, wheat dextrin, stimulant laxatives, docusate or lubiprostone) during the prior six months. Approximately one-third to two-thirds of patients on these older medicines reported lacking confidence in their ability to have a bowel movement (BM) at least once every other day, and the majority stated that they could not predict when their BM would take place after taking their medication. Overall, the majority of CIC patients participating in the study were “not at all” or “a little” satisfied with the older medications’ ability to relieve their constellation of constipation and abdominal symptoms.
Despite the fact that the CIC patients participating in the study who had taken laxatives and other older medications during the prior 6 months reported being generally unsatisfied, these medications continued to be widely used with these patients. We believe these findings indicate the importance of obtaining a detailed history from CIC patients to understand what constipation medications they have tried and their level of satisfaction with these, and the need to revisit how well a constipation medication is working over time. The persistence of an unmet treatment need among these CIC patients who have utilized these older medications may also warrant consideration of different classes of treatments, such as guanylate cyclase-C (GC-C) agonists, that may effectively address the multiple bowel and abdominal symptoms experienced by these patients.
What do patients need to know?
First, you are not alone in suffering from symptoms of chronic idiopathic constipation (CIC) and, as our research showed, it is very common for patients to not fully respond to many older, commonly used classes of constipation medications, even though these are often prescribed as first-line therapy after lifestyle and dietary modifications have failed.
Second, in our study, the majority of CIC patients taking certain older medications could not predict when a BM would take place and were “not at all” or “a little” satisfied with the medications’ ability to relieve their constipation and abdominal symptoms.
Third, talk to your doctor if you suffer from CIC, and be sure to tell them any medications you have already tried, how you responded to those medications, and all of the symptoms you are experiencing.
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