Magazine article Clinical Psychiatry News

IBS Drug Approved for Idiopathic Constipation

Magazine article Clinical Psychiatry News

IBS Drug Approved for Idiopathic Constipation

Article excerpt

Tegaserod, approved in 2002 for constipation-predominant irritable bowel syndrome in women, was recently approved by the Food and Drug Administration for treating chronic idiopathic constipation in women and men younger than 65.

The approval of tegaserod, marketed as Zelnorm by Novartis, was based on the results of two 12-week studies of patients with chronic constipation (lasting at least 6 months). More than 80% had fewer than two complete spontaneous bowel movements (CSBMs) per week at baseline. Among more than 2,000 patients under age 65, 45% of patients on 6 mg twice daily had an increase of at least one CSBM per week during 12 weeks of treatment, vs. 38% of those on 2 mg twice daily and 28% of patients on placebo.

The recommended dosage for chronic constipation is 6 mg orally twice daily before meals, the same dose recommended for IBS. Tegaserod, a

5-H[T.sub.4] receptor partial agonist, activates 5-H[T.sub.4] receptors in the gut, increasing GI motility, according to Novartis.

At a meeting in July, the FDA's gastrointestinal drugs advisory panel voted 10-3 to recommend approval of tegaserod for this indication; most panel members agreed that approval should be limited to women, who made up 90% of the patients enrolled in clinical trials, although several panelists said men should also have access to the drug. The three panel members voting against approval had concerns about the drug's risks, efficacy, or potential overuse for this indication.

The drug works primarily as a prokinetic agent, enhancing peristaltic reflux in the gut, Charlene Prather, M.D., of St. Louis University, Mo., said in an interview.

Study results were averaged; the drug worked very well for some patients and did not work for others, noted Dr. Prather, who spoke on behalf of Novartis at the FDA meeting. (She is a consultant and speaker for the company but was not an investigator in the trials).

She estimates the drug is effective in 60%-70% of the typical severely constipated patients she sees in her specialized practice. …

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