Benefits from long-term treatment in irritable bowel syndrome

Abstract

It is known that irritable bowel syndrome (IBS) is a chronic disease of cyclic nature characterized by recurrent symptoms. IBS patients should receive, as initial therapeutic approach a short course of treatment which, if effective, has the additional value of confirming the diagnosis. Long-term treatment should be reserved to diagnosed IBS patients with recurrent symptoms. Clinical trials with stabilized therapies and new active treatments showed an improvement of the symptoms over placebo that is often time-dependent but with high relapse rates (around 40%-50% when stopping treatment). Relapse is not always immediate after stopping treatment and the recent data from OBIS trial with otilonium bromide or with psychotherapy, showed that due to different chemico-physical characteristics of the drugs or the psychosomatic impact to the disease not all treatment gave the same relapsing rate if compared to placebo. Results of IBS clinical trials with different therapies tailored to the patient needs indicate that a cyclic treatment therapy is advisable to counteract the nature of the disease.

Figure 1

Representative diagram of the stability over time of IBS: percentage of the patients reporting IBS after 1 and 7 years from the first interview. Modified from [1].

Figure 2

Placebo response plotted against length of trial for 27 randomised controlled trials performed during 1976–1998. There are not enough data points between 3–6 months, but it appears that the placebo response increases and then decreases with time, peaking at 8 weeks. Modified from [7].

Figure 3

Mean abdominal pain/discomfort score (a) and bloating score (b) in patients cohort enrolled in retreatment phase with tegaserod. Modified from [8].

Figure 4

Percentage of the patients relapsing during the follow-up treatment free-period (at 3, 6, and 10 weeks) after 12 weeks treatment with placebo or otilonium bromide. *P < 0.05 as compared to respective placebo group. From OBIS trial [9].

Figure 5

Effect of long-term treatment with otilonium bromide on pain episodes (a) and bowel habits (b) reported by patients. Modified from [10].

Figure 6

Effect of 1-year treatment with alosetron or placebo and percentage of patients with adequate relief after 1 month of followup. *P < 0.05 as compared to respective placebo group. Modified from [11].