Assessing the post-treatment therapeutic effect of pinaverium in irritable bowel syndrome: a randomized controlled trial

Abstract

Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder significantly decreasing patients' lives of quality and placing huge economic burden on our society. Existing studies indicated that the therapeutic effects maintained for a period of time after the treatments were discontinued. It is clinically important to assess these post-treatment therapeutic effects (PTTE), which prevent IBS from relapsing. To assess the PTTE in pinaverium treatment and obtain high-quality evidence to justify the use of PTTE for long-term IBS management, we performed this controlled, double blind study on patients with IBS who were randomized to pinaverium 50 mg (n = 132) or placebo (n = 132), three times daily, for 4 weeks, and were followed up for 57 weeks after the treatments. The primary endpoints were abdominal pain and stool consistency. The secondary endpoints were pain frequency and stool frequency. The tertiary endpoints were global overall symptom and adverse events. Three days after pinaverium was discontinued, endpoints rebounded only 23.2-42.8% (P < 0.015 cf. placebo). The PTTE (P < 0.05 cf. placebo) lasted 9-17 weeks, which is similar to other antispasmodics with a 15-week treatment in striking contrast to ≥ 1 year PTTE in cognitive behavior therapy and < 1 week PTTE in serotonin antagonist treatment indicating that PTTE length markedly depends on the medication class used for the treatment and less depends on treatment length. After 17 weeks, the stage could be considered as an IBS natural history [no significant differences between pinaverium and placebo (all endpoints' P's > 0.05)], during which an average of 51.5-56.4% of patients (pool pinaverium and placebo data together) had IBS symptoms. These results provide clinical insights into efficient and cost-effective management of refractory IBS, and lend support to the IBS management that the selection of a therapy should consider both its effectiveness during treatment and its PTTE after the treatment.Trial registration number: NCT02330029 (16/08/2016).

Figure 1

Flowchart of the trial.

Figure 2

The time course of the endpoints during the treatment and post-treatment (intention-to-treat population; n = 132 for each group). Error bars indicate 95% confidence intervals. The numeric values of the endpoints were listed in Supplemental Material Tables S5 (intention-to-treat population) and S6 (per-protocol population). The t test comparing pinaverium with placebo is indicated by * (P < 0.05). Bottom panel: Responses of each endpoint during the treatment and post-treatment were normalized.

Figure 3

(A) Kaplan–Meier analysis on the relapse-free events as measured by the symptomatic endpoints (pinaverium: n = 85, 72, 88, and 72 for pain, stool consistency, pain frequency, and stool frequency, respectively; placebo: n = 42, 42, 45, and 49; see the Supplemental Material). (B). Distributions of relapses as measured by global overall symptom scales, which were nonlinearly regressed by Gaussian processes. See the Supplemental Material for details.