Constipation-predominant irritable bowel syndrome: A review of current and emerging drug therapies

Table 7 Quality of evidence supporting different pharmacologic agents for constipation-predominant irritable bowel syndrome and chronic constipation

Pharmacologic agent	Quality of evidence for IBS-C	Quality of evidence for CC
Laxatives
Psyllium	No RCTs	Moderate
Docusate sodium	No RCTs	Low
Lactulose	No RCTs	Moderate
PEG	Moderate	High
Senna	No RCTs	Low
Bisacodyl	No RCTs	Moderate
Prokinetics
Prucalopride	No RCTs	High
Naronapride	No RCTs	Low
Velusetrag	Low	Low
Rose-010	Moderate	No RCTs
Secretagogues
Lubiprostone	High	High
Linaclotide	High	High
Plecanatide	Low	Low
Bile acid modulators
CDC	Low	Low
Elobixibat	No RCTs	Moderate

The quality of evidence was assessed according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system[86], which defines study quality as high (further research is very unlikely to change confidence in the estimated effect); moderate (further research is likely to have an important impact on confidence in the estimated effect and may change the estimate); low (further research is very likely to have an important impact on confidence in the estimated effect and is likely to change the estimate); or very low (any estimate of effect is very uncertain). CC: Chronic constipation; CDC: Chenodeoxycholate; IBS-C: Constipation-predominant irritable bowel syndrome; PEG: Polyethylene glycol; RCT: Randomized controlled trials.