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Diarrhea-Predominant and Constipation-Predominant Irritable Bowel Syndrome: Current Prescription Drug Treatment Options

  • Therapy in Practice
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Abstract

Irritable bowel syndrome (IBS) is a heterogenous disease with a variety of therapeutic options, including eight prescription drugs approved for use in IBS in the USA. Choosing among the myriad treatment options requires attention to patient preferences both on clinical outcomes and costs associated with treatment. We performed a narrative review of the literature to summarize these important determinants of treatment choice including: labeled indications; clinical profiles of efficacy, safety, and tolerability of prescription drugs; and cost-effectiveness for diarrhea-predominant IBS drugs (IBS-D: alosetron, eluxadoline, and rifaximin) and constipation-predominant IBS drugs (IBS-C: linaclotide, lubiprostone, plecanatide, tegaserod, and tenapanor). We then review the standard model of shared decision-making aimed at guiding an informed, patient-centered discussion to integrate comparative clinical and cost outcomes toward choosing an IBS treatment in practice.

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Authors and Affiliations

  1. Geisel School of Medicine, Hanover, NH, USA

    Emily V. Wechsler & Eric D. Shah

  2. Center for Gastrointestinal Motility, Esophageal, and Swallowing Disorders, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03766, USA

    Emily V. Wechsler & Eric D. Shah

  3. The Dartmouth Institute, Lebanon, USA

    Eric D. Shah

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  1. Emily V. Wechsler
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Correspondence to Eric D. Shah.

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Funding

E.D. Shah is supported by the AGA Research Foundation’s 2019 American Gastroenterological Association-Shire Research Scholar Award in Functional GI and Motility Disorders.

Conflict of interest

Dr. Shah received travel reimbursement from Bausch Health outside the published work. Dr. Shah is a consultant for GI Supply/Laborie outside the published work. The other authors do not have any conflicts to declare.

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All authors contributed to the study conception and design. The initial manuscript was drafted by EW and edited by both authors. All authors read and approved the final manuscript.

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Wechsler, E.V., Shah, E.D. Diarrhea-Predominant and Constipation-Predominant Irritable Bowel Syndrome: Current Prescription Drug Treatment Options. Drugs 81, 1953–1968 (2021). https://doi.org/10.1007/s40265-021-01634-7

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