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Benefit/risk ratio of Renzapride not sufficient to warrant further study in IBS-C
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Clinical trial: renzapride treatment of women with irritable bowel syndrome and constipation – a double-blind, randomized, placebo-controlled, study
A. J. LEMBO*, F. CREMONINI*, N. MEYERS† & R. HICKLING†
*Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA ; †Alizyme Therapeutics Ltd, Cambridge, UK
Correspondence to Dr A. J. Lembo, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rabb/Rose 1, Boston, MA 02215, USA.
Copyright Journal compilation © 2010 Blackwell Publishing Ltd
Aliment Pharmacol Ther 31, 979–990
ABSTRACT
Background
Renzapride, a 5-hydroxytryptamine type-4 (5-HT4) receptor agonist and 5-HT3 receptor antagonist, has been proposed as a new treatment of irritable bowel syndrome with constipation (IBS-C).
Aim
To assess the efficacy and safety of renzapride in women with IBS-C.
Methods
Women with IBS-C were randomized to renzapride 4 mg daily, 2 mg b.d. or placebo for 12 weeks. The primary outcome measure was global relief of IBS symptoms. A subset of patients were enrolled in a 12-month, open-label study of renzapride 4 mg daily.
Results
A total of 1798 patients were included in the efficacy analysis and 971 patients entered the long-term study. The mean (S.E.M.) number of months with relief of overall IBS symptoms was 0.55 (0.04), 0.60 (0.04) and 0.44 (0.04) in the renzapride 4 mg daily, 2 mg b.d. and placebo groups (P = 0.027 and P = 0.004 respectively). Small yet statistically significant differences in favour of renzapride were observed on stool consistency and frequency, and bloating/abdominal distension scores. Renzapride was generally well tolerated; however, three episodes of ischaemic colitis were reported in the long-term study.
Conclusion
Given the limited increase in efficacy over placebo and the incidence of ischaemic colitis observed, our data suggest that the benefit/risk ratio of renzapride is not sufficient to warrant further study in IBS-C.
Publication data Submitted 9 November 2009 First decision 30 November 2009 Resubmitted 8 February 2010 Accepted 10 February 2010 Epub Accepted Article 16 February 2010
http://www3.interscience.wiley.com/journal/123286564/abstract
