A recent study (AJ Lembo et al. NEJM 2016; 374: 242-53) found that eluxadoline, an oral agent with mixed opioid effects was helpful in some with irritable bowel syndrome with diarrhea (IBS-D).
Study methods: 2427 adults with IBS-D received either 75 mg, 100 mg of study medication or placebo twice daily for 26 weeks. The primary endpoint was a composite response of decreased abdominal pain and stool consistency.
While the absolute difference in response compared to placebo appears modest (see Figure above), the authors note that the treatment effects “were similar to those reported with alosetron and rifaximin.” Adverse effects included nausea (7.5% in 100 mg group compared with 5.1% in placebo), constipation (8.6%% in 100 mg group compared with 2.5% in placebo), and abdominal pain (7.2% in 100 mg group compared with 4.1% in placebo). Pancreatitis developed in 5 patients in the treatment group (0.3%).
My take: While Eluxadoline helped some with IBS-D, better, more effective treatments are needed.
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