Syndrome de l’intestin irritable : pourquoi est-il si difficile de trouver un traitement efficace ?

Irritable bowel syndrome: why is it so difficult to discover an efficacious drug?

Résumé

La mise au point d’un traitement médicamenteux « universel » du syndrome de l’intestin irritable se heurte à de multiples obstacles difficiles à surmonter. L’absence de mécanisme physiopathologique unique, la grande variabilité des symptômes dans le temps, les troubles psychologiques associés, l’importance de l’effet placebo, la définition des critères d’évaluation, et la durée du traitement, sont les principales difficultés rencontrées lors des essais thérapeutiques. En outre, la tolérance du traitement au cours des essais, mais aussi lors des études de phase IV postmarketing sont des éléments primordiaux à prendre en considération compte tenu du fait que l’on s’adresse à une pathologie, certes invalidante, mais ne mettant pas en jeu le pronostic vital.

Abstract

Finding a unique drug to treat irritable bowel syndrome has several challenges that are difficult to overcome. The lack of a single pathophysiological mechanism, the great variation in symptoms over time, associated psychological problems; the importance of the placebo effect, the definition of endpoints, and the duration of treatment are the main issues of therapeutic trials. Moreover, drug tolerance and side effects in both therapeutic trials and phase IV postmarketing studies are both key factors to be considered given that a disease, which is disabling but not life-threatening disease is the issue.

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Correspondence to O. Chassany.

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Duracinsky, M., Chassany, O. Syndrome de l’intestin irritable : pourquoi est-il si difficile de trouver un traitement efficace ?. Colon Rectum 1, 248–254 (2007). https://doi.org/10.1007/s11725-007-0059-3

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Mots clés

  • Syndrome de l’intestin irritable
  • Études cliniques
  • Effet placebo

Keywords

  • Irritable bowel syndrome
  • Clinical trials
  • Placebo effect