Table 1

Summary of evidence from trial-based meta-analyses and network meta-analyses concerning the efficacy of drugs for IBS

Patient group tested inDrug and doseQuality of data56 Adverse events56 84 Ranking according to network meta-analysis35 76 87
Efficacy in terms of global symptoms (no. of RCTs and patients)Efficacy in terms of composite endpoint (abdominal pain and bowel habit)
(no. of RCTs and patients)
Efficacy in terms of abdominal pain
(no. of RCTs and patients)
Efficacy in terms of bowel habit
(no. of RCTs and patients)
Unselected patients with IBSSoluble fibre (eg, ispaghula 6–30 g/day)ModerateTotal adverse events no more common in three RCTsFourth
(6 RCTs,
161 patients)
N/AFifth
(2 RCTs,
125 patients)
N/A
Antispasmodics (eg, hyoscine 20 mg t.i.d.)Very lowTotal adverse events significantly more common in a meta-analysis of 26 RCTs, particularly dry mouth, dizziness and blurred visionThird
(16 RCTs,
953 patients)
N/ASecond
(10 RCTs,
549 patients)
N/A
Peppermint oil 200 mg t.i.d.LowTotal adverse events no more common in a meta-analysis of six RCTsFirst
(6 RCTs,
342 patients)
N/AThird
(4 RCTs,
260 patients)
N/A
Tricyclic antidepressants (eg, amitriptyline 10–30 mg o.d.)ModerateTotal adverse events significantly more common in a meta-analysis of six RCTs, particularly dry mouth and drowsinessSecond
(10 RCTs,
376 patients)
N/AFirst
(4 RCTs,
92 patients)
N/A
Selective serotonin re-uptake inhibitors (eg, fluoxetine 20 mg o.d.)LowTotal adverse events no more commonFifth
(5 RCTs,
143 patients)
N/AFourth
(5 RCTs,
131 patients)
N/A
Patients with IBS-CLinaclotide 290 mcg o.d.HighDiarrhoea significantly more common in a meta-analysis of three RCTsFirst
(4 RCTs,
2617 patients)
First
(3 RCTs,
2447 patients)
First
(3 RCTs,
2447 patients)
First
(3 RCTs,
2447 patients)
Lubiprostone 8 mcg b.i.d.ModerateNausea significantly more common in a meta-analysis of three RCTsSeventh
(3 RCTs,
1271 patients)
Third
(2 RCTs,
452 patients)
Fifth
(2 RCTs,
452 patients)
N/A
Plecanatide 6 mcg o.d.ModerateDiarrhoea significantly more common in a meta-analysis of two RCTsFifth
(2 RCTs,
1461 patients)
Fifth
(2 RCTs,
1461 patients)
Fourth
(2 RCTs,
1461 patients)
Fifth
(2 RCTs,
1461 patients)
Tenapanor 50 mcg b.i.d.ModerateRates of diarrhoea numerically higherFourth
(3 RCTs,
1382 patients)
Second
(3 RCTs,
1401 patients)
Second
(3 RCTs,
1401 patients)
Third
(3 RCTs,
1401 patients)
Patients with IBS-D or IBS-MAlosetron 1 mg b.i.d.HighConstipation significantly more common in a meta-analysis of three RCTsFirst
(2 RCTs,
1154 patients)
First
(3 RCTs,
787 patients)
Third
(6 RCTs,
2606 patients)
First
(1 RCT,
280 patients)
Eluxadoline 100 mg b.i.d.ModerateRates of constipation, nausea and vomiting numerically higher in a pooled analysis of two RCTsFourth
(4 RCTs,
2312 patients)
Third
(4 RCTs,
2312 patients)
Fifth
(4 RCTs,
2312 patients)
Sixth
(4 RCTs,
2312 patients)
Ramosetron 2.5 mcg o.d.ModerateTotal adverse events no more common in a meta-analysis of five RCTsSecond
(2 RCTs,
782 patients)
Second
(1 RCT,
348 patients)
First
(2 RCTs,
782 patients)
Fourth
(2 RCTs,
782 patients)
Rifaximin 550 mg t.i.d.ModerateTotal adverse events no more common in a pooled analysis of three RCTsSixth
(2 RCTs,
1260 patients)
Fifth
(2 RCTs,
1260 patients)
Sixth
(2 RCTs,
1260 patients)
Third
(2 RCTs,
1260 patients)
  • b.i.d., two times per day; IBS, irritable bowel syndrome; IBS-C, IBS with constipation; IBS-D, IBS with diarrhoea; IBS-M, IBS mixed; o.d., once daily; RCTs, randomised controlled trials; t.i.d., three times per day.