Plecanatide Improves Abdominal Bloating and Bowel Symptoms of Irritable Bowel Syndrome with Constipation

Background Bloating is a bothersome symptom in irritable bowel syndrome with constipation (IBS-C). Aim To evaluate plecanatide efficacy in patients with IBS-C stratified by bloating intensity. Methods Pooled phase 3 data (2 randomized, controlled IBS-C trials) from adults treated with plecanatide 3 mg or placebo for 12 weeks were analyzed. Patients were stratified post-hoc by baseline bloating severity (11-point scale: mild [<= 5] and moderate-to-severe [>5]). Assessments included change from baseline in bloating, abdominal pain, and complete spontaneous bowel movement (CSBM) frequency. Abdominal pain and bloating composite responders were defined as patients with >= 30% improvement from baseline in both bloating and abdominal pain at Week 12. Results At baseline, 1104/1436 patients with IBS-C (76.9%) reported moderate-to-severe bloating. In the moderate-to-severe bloating subgroup, plecanatide significantly reduced bloating severity versus placebo (least-squares mean change [LSMC]: - 1.7 vs - 1.3; P=0.002), reduced abdominal pain (- 1.7 vs - 1.3; P=0.006), and increased CSBM frequency (1.4 vs 0.8; P<0.0001). In the mild bloating subgroup, significant improvements were observed with plecanatide versus placebo for abdominal pain (LSMC: - 1.3 vs - 1.0; P=0.046) and CSBM frequency (2.0 vs 1.2; P=0.003) but not bloating (- 0.9 vs - 0.8; P=0.28). A significantly greater percentage of patients were abdominal pain and bloating composite responders with plecanatide versus placebo (moderate-to-severe bloating: 33.6% vs 26.8% [P=0.02]; mild bloating: 38.4% vs 27.2% [P=0.03]). Conclusion Plecanatide treatment improved IBS-C abdominal and bowel symptoms, including in those who present with moderate-to-severe bloating.