Repeat Treatment With Rifaximin Is Safe and Effective in Patients With Diarrhea-Predominant Irritable Bowel Syndrome

Lembo, Anthony; Pimentel, Mark; Rao, Satish S.; Schoenfeld, Philip; Cash, Brooks D.; Weinstock, Leonard B.; Paterson, Craig; Bortey, Enoch; Forbes, William

doi:10.1053/j.gastro.2016.08.003

Cited by 237 publications

(255 citation statements)

References 27 publications

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“…A significantly greater percentage of patients in the rifaximin group (38.1%) responded (≥30% decrease from baseline in mean weekly pain score for abdominal pain and ≥50% decrease from baseline in the number of days with mushy/watery stools [Bristol Stool Scale type 6 or 7]) for ≥2 of 4 weeks posttreatment compared with placebo (31.5%; P = 0.03) [112]. Repeat treatment with rifaximin was generally well tolerated.…”

Section: Antibioticsmentioning

confidence: 93%

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Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

Harris

Baffy

2017

Postgraduate Medicine

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Irritable bowel syndrome (IBS), which is characterized by recurrent abdominal pain and disordered bowel habits, is one of the most common functional bowel disorders. IBS is a substantial burden on both patient health-related quality of life and healthcare costs. Several pathophysiologic mechanisms have been postulated for the occurrence of IBS, including altered gastrointestinal motility, visceral hypersensitivity, changes in gut permeability, immune activation, gut-brain dysregulation, central nervous system dysfunction, and changes in the gut microbiota. Of note, both qualitative and quantitative differences have been observed in the gut microbiota of a population with IBS versus a healthy population. Because of the substantial interest in the gut microbiota and its role as a therapeutic target in IBS, this article provides an overview of specific interventions with the potential to modulate the gut microbiota in IBS, including elimination diets, prebiotics, probiotics, synbiotics, and nonsystemic antibiotics. Although probiotics and synbiotics are generally well tolerated, differences in the composition and concentration of different bacterial species and inclusion or exclusion of prebiotic components varies widely across studies and has prevented strong recommendations on their use in IBS. For nonsystemic antibiotics, rifaximin is indicated in the United States for the treatment of IBS with diarrhea in adults and has been shown to be efficacious and well tolerated in well-designed clinical trials. Overall, more consistent evidence is needed regarding the efficacy and safety of elimination diets, prebiotics, probiotics, and synbiotics for the treatment of patients with IBS. Furthermore, additional well-designed studies are needed that examine alterations in the gut microbiota that occur with these interventions and their potential associations with clinical symptoms of IBS. ARTICLE HISTORY

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Section: Antibioticsmentioning

confidence: 93%

“…Because rifaximin is administered as short-course therapy (i.e. 2 weeks) for IBS-D, a phase III retreatment study was conducted to evaluate if patients with IBS-D who initially responded to rifaximin and then experienced symptom recurrence would respond to 2-week repeat treatment [112].…”

Section: Antibioticsmentioning

confidence: 99%

Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

Harris

Baffy

2017

Postgraduate Medicine

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“…12 TARGET 3 was a third phase III clinical trial designed to address concerns of the FDA regarding the efficacy, safety, and potential emergence of resistant bacterial strains with multiple treatments with rifaximin in IBS-D patients who initially experienced a therapeutic response to the medication, but subsequently suffered a relapse of symptoms. 13 All enrolled patients were initially treated in a blinded fashion with placebo, and those who failed to respond to placebo during this 'precebo' phase were treated with open-label rifaximin 550 mg TID for 14 days. Responders were defined as those who experienced a simultaneous ⩾30% decrease from baseline mean abdominal pain score and ⩾50% decrease from baseline in the number of days per week with Bristol Stool Form Scale type 6 or 7 for at least 2 of the 4 weeks post-treatment.…”

Section: Rifaximinmentioning

confidence: 99%

“…The patient had a past medical history of C. difficile infection and developed C. difficile colitis immediately after completing a 10-day course of a cephalosporin for a urinary tract infection. 13 …”

Section: Rifaximinmentioning

confidence: 99%

The place of eluxadoline in the management of irritable bowel syndrome with diarrhea

Levio

Cash

2017

Therap Adv Gastroenterol

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Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by abdominal pain associated with defecation with altered stool frequency or stool form. The global prevalence of IBS ranges from 10% to 15% and total healthcare cost attributable to IBS is significant. Among individuals with IBS, the condition has dramatic effects on health-related quality of life, work and school productivity, and activities of daily living. It may be diagnosed with confidence, based on symptom-based diagnostic criteria, exclusion of alarm features and directed diagnostic testing. Management of IBS typically begins with dietary and lifestyle modifications, progressing to over-the-counter therapies, and then to prescription medications, both approved and nonapproved for IBS. This narrative summarizes the efficacy and safety of three US Food and Drug Administration (FDA)-approved prescription therapies for IBS with diarrhea (IBS-D), with a focus on the most recently marketed agent, eluxadoline, and its role in the treatment IBS-D.

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“…To untangle this knot, a third trial, the TARGET-3 [7], has investigated the efficacy of rifaximin re-treatment in IBS-D patients who experienced symptomatic relapse after an initial successful treatment with rifaximin. Among 1074 patients who initially responded to rifaximin 550 mg tid for two weeks in the open-label phase, 692 relapsed during the observation phase and 636 of them were randomly assigned to receive a second course of rifaximin (328) or placebo (308).…”

mentioning

confidence: 99%

Rifaximin Re-treatment in Patients with Irritable Bowel Syndrome: Feels Like the First Time?

2017

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Repeat Treatment With Rifaximin Is Safe and Effective in Patients With Diarrhea-Predominant Irritable Bowel Syndrome

Abstract: In a phase 3 study of patients with relapsing symptoms of IBS-D, repeat rifaximin treatment was efficacious and well tolerated. ClinicalTrials.gov ID: NCT01543178.

Cited by 237 publications

References 27 publications

Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

The place of eluxadoline in the management of irritable bowel syndrome with diarrhea

Rifaximin Re-treatment in Patients with Irritable Bowel Syndrome: Feels Like the First Time?

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