The effect of antispasmodics on pain of patients with irritable bowel syndrome
Level of evidence: D
Antispasmodics may decrease symptoms of irritable bowel syndrome, but the evidence is very uncertain.
In a systematic review and network meta-analysis including 20 small trials on antispasmodics, antispasmodics improved overall symptoms of irritable bowel symptoms as well as abdominal pain in 4-12 weeks follow up «Black CJ, Yuan Y, Selinger CP, et al. Efficacy of soluble fibre, antispasmodic drugs, and gut-brain neuromodulators in irritable bowel syndrome: a systematic review and network meta-analysis. Lancet G»1. Dichotomized outcomes decrease the interpretability of clinical relevance. Total adverse events slight to no difference between control and intervention groups (RR 1.14, 95% confidence interval 0.88-1.47), numbers for specific adverse events were not reported.
The evidence was limited by risk of bias, imprecision and inconsistency.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| «Black CJ, Yuan Y, Selinger CP, et al. Efficacy of soluble fibre, antispasmodic drugs, and gut-brain neuromodulators in irritable bowel syndrome: a systematic review and network meta-analysis. Lancet G»1 | SR/MA | Patients 18 years or older, with a diagnosis of IBS based on clinician's opinion or specific diagnostic criteria. | Antispasmodics (alverine, cimetropium, drotaverine, hyoscine, mebeverine, otilonium, pargeverine, pinaverium, pirenzipine, trimebutine) or placebo (I 1100/C 1064) | Proportion of patients failing to achieve an improvement in global IBS symptoms or abdominal pain | High |
| Reference | Comments |
|---|---|
| «Black CJ, Yuan Y, Selinger CP, et al. Efficacy of soluble fibre, antispasmodic drugs, and gut-brain neuromodulators in irritable bowel syndrome: a systematic review and network meta-analysis. Lancet G»1 | Individual studies had differing definitions of IBS, mostly small sample sizes, data was extracted for 4–12-week duration of treatment, different active ingredients that belong to the group of antispasmodics. Mostly unclear risk of bias concerning method of generation of randomisation schedule (17 studies) and concealment of treatment allocation (18 studies), in 5 studies high risk of bias due to missing data. |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: very low The quality of evidence it was limited by study limitations, imprecision and inconsistency. | |||||
| «Black CJ, Yuan Y, Selinger CP, et al. Efficacy of soluble fibre, antispasmodic drugs, and gut-brain neuromodulators in irritable bowel syndrome: a systematic review and network meta-analysis. Lancet G»1 | 20 RCTs 2164 patients (I 1100/C 1064) | 4-12 weeks | RR 0.76 (0.64;0.90) | ||
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: very low The quality of evidence it was limited by study limitations, imprecision and inconsistency. | |||||
| «Black CJ, Yuan Y, Selinger CP, et al. Efficacy of soluble fibre, antispasmodic drugs, and gut-brain neuromodulators in irritable bowel syndrome: a systematic review and network meta-analysis. Lancet G»1 | 20 RCTs 2164 patients (I 1100/C 1064) | 4-12 weeks | RR 0.64 (0.49;0.84) | ||
Comment: In Finland, a muscarinic antagonist clidinium bromide has marketing authorisation for IBS indication as a combination product with chlordiazepoxide, which belongs to benzodiazepines and cannot therefore be recommended for long-term use. Finnish Medicines Agency Fimea may grant a special permit for a medicinal product without a marketing authorisation. Currently anticholinergics butylscopolamine, hyoscyamine and mebeverine are available with a special permit.
References
- Black CJ, Yuan Y, Selinger CP, et al. Efficacy of soluble fibre, antispasmodic drugs, and gut-brain neuromodulators in irritable bowel syndrome: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol 2020;5(2):117-131 «PMID: 31859183»PubMed