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Efficacy of 5-HT3 antagonists and 5-HT4 agonists in irritable bowel syndrome: systematic review and meta-analysis.
Am J Gastroenterol 2009; 104(7):1831-43; quiz 1844AJ

Abstract

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 (RR=0.85; 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.

Authors+Show Affiliations

Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada. alexf12399@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

19471254

Citation

Ford, Alexander C., et al. "Efficacy of 5-HT3 Antagonists and 5-HT4 Agonists in Irritable Bowel Syndrome: Systematic Review and Meta-analysis." The American Journal of Gastroenterology, vol. 104, no. 7, 2009, pp. 1831-43; quiz 1844.
Ford AC, Brandt LJ, Young C, et al. Efficacy of 5-HT3 antagonists and 5-HT4 agonists in irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol. 2009;104(7):1831-43; quiz 1844.
Ford, A. C., Brandt, L. J., Young, C., Chey, W. D., Foxx-Orenstein, A. E., & Moayyedi, P. (2009). Efficacy of 5-HT3 antagonists and 5-HT4 agonists in irritable bowel syndrome: systematic review and meta-analysis. The American Journal of Gastroenterology, 104(7), pp. 1831-43; quiz 1844. doi:10.1038/ajg.2009.223.
Ford AC, et al. Efficacy of 5-HT3 Antagonists and 5-HT4 Agonists in Irritable Bowel Syndrome: Systematic Review and Meta-analysis. Am J Gastroenterol. 2009;104(7):1831-43; quiz 1844. PubMed PMID: 19471254.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of 5-HT3 antagonists and 5-HT4 agonists in irritable bowel syndrome: 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, Y1 - 2009/05/26/ PY - 2009/5/28/entrez PY - 2009/5/28/pubmed PY - 2009/7/25/medline SP - 1831-43; quiz 1844 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 104 IS - 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 (RR=0.85; 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. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/19471254/Efficacy_of_5_HT3_antagonists_and_5_HT4_agonists_in_irritable_bowel_syndrome:_systematic_review_and_meta_analysis_ L2 - http://Insights.ovid.com/pubmed?pmid=19471254 DB - PRIME DP - Unbound Medicine ER -