Introduction Choosing drug therapy for irritable bowel syndrome (IBS) requires balancing symptom benefit against treatment-related adverse effects. While clinicians often use the number needed to treat (NNT) to compare efficacy, the number needed to harm (NNH) offers an equally important perspective by estimating how many patients need to be treated before one stops therapy because of an adverse event.
Introduction
Choosing drug therapy for irritable bowel syndrome (IBS) requires balancing symptom benefit against treatment-related adverse effects. While clinicians often use the number needed to treat (NNT) to compare efficacy, the number needed to harm (NNH) offers an equally important perspective by estimating how many patients need to be treated before one stops therapy because of an adverse event. This systematic review and meta-analysis evaluated the safety of commonly used IBS medications by focusing on discontinuation due to adverse events, a pragmatic marker of tolerability.
Summary
This meta-analysis included 54 placebo-controlled clinical trials involving 33,538 patients and assessed IBS-C, IBS-D, and global symptom therapies. The primary outcome was NNH, derived from treatment discontinuation due to adverse events.
Among IBS-C therapies, the NNH was 35 for linaclotide, 53 for lubiprostone, 59 for plecanatide, 58 for tegaserod, and 16 for tenapanor. For IBS-D therapies, the NNH was 14 for alosetron and 32 for eluxadoline, while rifaximin and ramosetron had negative, nonsignificant NNH values, meaning placebo groups had numerically higher discontinuation rates than active treatment groups. For global IBS symptom therapy, tricyclic antidepressants had an NNH of 24.
Overall, tenapanor, alosetron, and tricyclics had the greatest risk of treatment discontinuation due to adverse events, whereas rifaximin appeared to be the safest pharmacotherapy studied. The most common adverse effects reflected mechanism of action: diarrhea and nausea for IBS-C drugs, constipation for IBS-D drugs, and anticholinergic or sedative effects for tricyclics. Importantly, many adverse events were transient and nonserious.
This study emphasizes that IBS treatment decisions should not rely on efficacy alone. Safety, tolerability, and patient preference should be central when selecting among multiple reasonable drug options.
Introduction: Anal squamous cell carcinoma is an increasingly common but largely preventable cancer. Most cases arise from persistent high-risk human papillomavirus (HPV) infection, progressing through high-grade squamous intraepithelial lesions (HSIL). This comprehensive review summarizes the...
Introduction: Acute infectious gastroenteritis can trigger persistent gastrointestinal symptoms long after the infection has resolved, leading to post-infection disorders of gut-brain interaction (PI-DGBI). This global Rome Foundation study evaluated the prevalence, risk factors, and clinical...
Introduction: Gut microbiota alterations have been implicated in the pathogenesis of irritable bowel syndrome (IBS), making fecal microbiota transplantation (FMT) a promising therapeutic strategy. However, clinical trials have reported conflicting results. This updated meta-analysis evaluated...
Introduction: Laparoscopic adhesiolysis offers several short-term advantages over open surgery for adhesive small bowel obstruction (ASBO). However, its long-term impact on recurrence, quality of life, and incisional hernia remains uncertain. The LASSO trial provides the...
Introduction: Growing evidence suggests that Parkinson's disease (PD) may originate in the gut, with pathological α-synuclein spreading to the brain through the vagus nerve. This study investigated whether sitagliptin, a widely used DPP-4 inhibitor for...
Introduction: Necrotizing enterocolitis (NEC) is one of the most serious gastrointestinal emergencies in neonates. Early identification of infants requiring surgical intervention is critical but remains challenging. This study compared bedside abdominal ultrasonography (US) with abdominal...
We are pioneers in clinical intelligence, dedicated to helping gastroenterologists harness the power of artificial intelligence to drive precision, efficiency, and patient growth.