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Meta-Analysis
. 2023 Jun;57(11):1258-1271.
doi: 10.1111/apt.17426. Epub 2023 Mar 3.

Randomised, placebo-controlled trial and meta-analysis show benefit of ondansetron for irritable bowel syndrome with diarrhoea: The TRITON trial

David Gunn  1   2 , Rabia Topan  3   4 , Lorna Barnard  5 , Ron Fried  3 , Ivana Holloway  5 , Richard Brindle  5 , Maura Corsetti  2 , Mark Scott  3 , Adam Farmer  6 , Kapil Kapur  7 , David Sanders  8 , Maria Eugenicos  9 , Nigel Trudgill  10 , Peter Whorwell  11 , John Mclaughlin  12 , Ayesha Akbar  13 , Lesley Houghton  14 , Phil G Dinning  15 , Qasim Aziz  3 , Alexander C Ford  16   17 , Amanda J Farrin  5 , Robin Spiller  1   2
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Free article
Meta-Analysis

Randomised, placebo-controlled trial and meta-analysis show benefit of ondansetron for irritable bowel syndrome with diarrhoea: The TRITON trial

David Gunn et al. Aliment Pharmacol Ther. 2023 Jun.
Free article

Abstract

Background: Ondansetron may be beneficial in irritable bowel syndrome with diarrhoea (IBS-D).

Aim: To conduct a 12-week parallel group, randomised, double-blind, placebo-controlled trial of ondansetron 4 mg o.d. (titrated up to 8 mg t.d.s.) in 400 IBS-D patients.

Primary endpoint: % responders using the Food and Drug Administration (FDA) composite endpoint. Secondary and mechanistic endpoints included stool consistency (Bristol Stool Form Scale) and whole gut transit time (WGTT). After literature review, results were pooled with other placebo-controlled trials in a meta-analysis to estimate relative risks (RR), 95% confidence intervals (CIs) and number needed to treat (NNT).

Results: Eighty patients were randomised. On intention-to-treat analysis, 15/37 (40.5%; 95% CI 24.7%-56.4%) met the primary endpoint on ondansetron versus 12/43 (27.9%; 95% CI 14.5%-41.3%) on placebo (p = 0.19). Ondansetron improved stool consistency compared with placebo (adjusted mean difference - 0.7; 95% CI -1.0 to-0.3, p < 0.001). Ondansetron increased WGTT between baseline and week 12 (mean (SD) difference 3.8 (9.1) hours, versus placebo -2.2 (10.3) hours, p = 0.01). Meta-analysis of 327 patients from this, and two similar trials, demonstrated ondansetron was superior to placebo for the FDA composite endpoint (RR of symptoms not responding = 0.86; 95% CI 0.75-0.98, NNT = 9) and stool response (RR = 0.65; 95% CI 0.52-0.82, NNT = 5), but not abdominal pain response (RR = 0.95; 95% CI 0.74-1.20).

Conclusions: Although small numbers meant the primary endpoint was not met in this trial, when pooled with other similar trials meta-analysis suggests ondansetron improves stool consistency and reduces days with loose stool and urgency. Trial registration - http://www.isrctn.com/ISRCTN17508514.

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