CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological...
Transcript of CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological...
![Page 1: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/1.jpg)
![Page 2: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/2.jpg)
FunctionaI GIDisorders
LouisW.C.LiuMD,PhD,FRCPC
HeadofGastroenterology,UniversityHealthNetworkandSinaiHealthSystem
Director,MotilityUnit,UniversityHealthNetwork
![Page 3: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/3.jpg)
TrendsinIBSHospitalizationsandFinancialBurdensinUSA
• UtilizedtheNationalInpatientSampledatabases,collectedaspartofAgencyforHealthcareCostandUtilizationProjectbyAgencyforHealthcareResearchandQuality
• HospitalizationsofadultswithprimarydiagnosisofIBSwerecapturedbyICD-9codes.
MASiddiqu etal,DDW2018,Su1196
• IBSrelatedEDvisitsincreasesovertimes• PrincipaldiagnosisadmissionwithIBSistrendingdown.
![Page 4: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/4.jpg)
TrendsinIBShospitalizationsandfinancialburdensinUSA
MASiddiqu etal,DDW2018,Su1196
![Page 5: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/5.jpg)
IBSwasrankedasoneofthetop10mostexpensiveGIdiseasesintheUS1
IBScomparedwithotherchronicconditionsinCanada
CanadianspermanentlyunabletoworkCanadianchronicdiseasesaccordingtoage
1. Fedorak RN, Vanner SJ, Paterson WG, Bridges RJ. CJG. 2012;26(5):252-256.2. Inadomi JM, Fennerty MB, Bjorkman D. APT. 2003 Oct 1; 18(7):671-823. Spiegel BM, Kanwal F, Naliboff B, Mayer E. AJG. 2005 Oct; 100(10):2262-734. Boivin M. CJG. 2001 Oct; 15 Suppl B():8B-11B.
![Page 6: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/6.jpg)
ImpactonHealthcareUtilization
*12%havebeenhospitalizedinthelast12monthsforreasonsrelatingtoIBS.
GISociety.2016.Availableat:http://www.badgut.org/wp-content/uploads/IBS-Survey-Results-2016.pdf.LastaccessedApril,2018.
• 6millionCanadianslivingwithIBS
• TheannualhealthcaredirectcosttreatingIBSexceeds$6.5billionnotincludingover-the-countermedicationorprescriptions.
• ApatientwithIBSmisses13workdaysperyear,accountingfor$8billion inlostproductivityannually
Understanding Irritable Bowel Syndrome. www.cdhf.ca.
Comments:impactonpolicymakers,resourcedistributionandutilizationbyprivateandpublicpayers
![Page 7: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/7.jpg)
IBS:Pathophysiology
ModifiedfromROMEIVSlideDeck.2016
![Page 8: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/8.jpg)
• Background:previousstudyfocusedonearlyadverselifeevents<18yroradulthoodeventoccurring3-12mo ofthestudyenrollment;associationoflifeeventsinadulthoodwithIBSandHPAfunctionhasnotbeenstudied
• Aim:determinetherelationshipbetweenstressfullifeeventsinadulthoodofhavingIBS,symptomseverityandHPAresponsetohormonechallenge.
• Method: ROMEIII(IBS:n=129,meanage26.1,66%F)cf healthycontrols(n=108,meanage29.8yr,60%F).– CompleteLifeExperiencesSurvey(LES)of60potentialeventsoccurring
sinceage18.Eventswereratedashavinganegativetopositivelifeimpactonascaleof-3to+3.Scoring includednumberofnegativeevents,negativeeventimpactscore(sumofnegativelyscoredevents),andtotaleventimpactscore(sumofpositivelyandnegativelyscoredevents).AdverseChildhoodExperiencessurvey(ACE),IBS-SSSandIBS-QOLwerecollected
– HPAregulation:cortisolandACTHresponsetoCRFweremeasuredin68IBSand41HC(controlforage,sexandBMI)
Parker,Cetal.DDW2018,oralpresentation454,SundayJune3.Stressfullifeeventsinadulthoodincreaseriskofirritablebowelsyndromeandsymptomsseverity
StressfullifeeventsincreaseIBSandsymptomseverity
![Page 9: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/9.jpg)
IBSsubjectshadahigheraveragenumberofnegativelyperceivedlifeevents(p=0.067),agreaternegativeeventimpactscore(p=0.022)andamorenegativetotaleventimpactscore(p<0.001).
• InIBSpatients,thethreelifeexperiencesurveyscoresincreasedIBS-SSS(p=0.059,p=0.025,andp=0.02)anddecreasedIBS-QOL(allp<0.001).
• GreaternegativelyperceivedlifeeventswasassociatedwithabluntedCRFstimulatedACTHresponseinIBSbutanincreasedresponseinHCs
Parker,Cetal.DDW2018,oralpresentation454,SundayJune3.Stressfullifeeventsinadulthoodincreaseriskofirritablebowelsyndromeandsymptomsseverity
StressfullifeeventsincreaseIBSandsymptomseverity
![Page 10: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/10.jpg)
• Conclusions:– Negativelyperceived lifeeventsinadulthoodareassociatedwithincreasedoddsofhavingIBS,worsesymptomseverityandQOL.
– HPAresponsetotheseeventswerebluntedinIBSpatients.ThebluntedACTHresponseinIBSmaybeduetoincreasedhypothalamicCRFsecretionandresultingdownregulationofCRF1receptorsinthepituitarygland.PositivelifeeventsappeartomitigateadverseeffectsinIBS.
• Comments:helptoeducateandvalidatepatients,reinforcetheutilityofCBTandpsycho- andnon-pharmacologicaltherapy
StressfullifeeventsincreaseIBSandsymptomseverity
Parker,Cetal.DDW2018,oralpresentation454,SundayJune3.Stressfullifeeventsinadulthoodincreaseriskofirritablebowelsyndromeandsymptomsseverity
![Page 11: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/11.jpg)
Louis Liu, Chris Andrews, David Armstrong, Alain Bitton, Brian Bressler, John MarshallContributing faculty members involved in the development of the algorithm
CARE Chronic Constipation Treatment Algorithm
e.g. Milk of Magnesia, Lactulose or PEG titrate to efficacy and tolerability +/- fibre supplementsEight-week trial at a reasonable dose prior to
reassessment of maintenance or escalation to step-up therapies
Additional Agents:Options as in slow transit*
(e.g. stimulant,osmotic laxative)
Additional Therapy:Pharmacological
eg. TCA, SSRI, SNRL antispasmodic
Non-Pharmacologicale.g. Medication,
Relaxation, Hypnosis
Fibre Supplements Osmotic Laxatives Prosecretory Agentse.g. Linaclotide Specialist Assessment for
Consideration of Anorectal Manometry, Defecography and Biofeedback Therapy
e.g. Linaclotide or PrucaloprideEight to twelve-week trial prior to reassessment for maintenance
or consideration of referral for specialist assessment
Prosecretory or Prokinetic Agents
Unsatisfactory Response or Intolerant to Side Effects
Specialist Assessment Recommended (Refer)
1. Glycerine suppository2. Stimulant laxatives (e.g. bisacodyl)3. Enema
Rescue Therapy
Constipation symptoms predominant
Functional abdominal pain predominant
TypeofConstipation?
LifestyleModifications(e.g.,DietaryFibre,Fluid,Exercise)
Inadequate Fibre Intake CIC/Slow Transit IBS-C Pelvic Floor DyssynergicDefecation
History&PhysicalIncludingCarefulPerineal/RectalExamination
AssessAlarmFeatures OptimizeManagementofSecondaryCauses
Alarm Features Identified No Alarm Features Identified Constipation Persists
Specialist AssessmentRecommended (Refer)
Patie
nt E
duca
tion
and
Mana
gem
ent o
f Exp
ecta
tions
Asse
ss fo
r Com
plex
or C
ompl
icatin
g Fe
atur
es
Tse Y et al CJGH 2017
![Page 12: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/12.jpg)
LinaclotideinJapanesepatientswithchronicconstipation• Background:PhaseIIandIIIstudiesforIBS-CinJapanshowedthat0.5mg/daywasthe
mosteffectivedose.AphaseIIdose-rangingstudyoflinaclotideinaJapanesechronicconstipation(CC)populationshowedthat0.5mg,adose3.4timeshigherthanthehighestapproveddoseintheUS,wasagainthemosteffectivedose.
• Aim: verifythat0.5mgoflinaclotideiseffectiveandsafeforCCpatientsinJapan.• Method: multicenter,phase3.ROMEIIICC.Phase1:4-weekplacebocontrol,
linaclotide0.5mgdaily.Phase2:52-weekopenlabel,doseadjustmentcanbemadeatweek4and12visits(0.25or0.5mg)dependingontolerability.
• Endpoints:– Primary:changeinSBM/weekatthe1stweekofadministration– Secondary:CSBM,stoolconsistency,andstrainingseverityscore
• Result:– Phase1:SBMfrequencyincreases(linaclotide,4.02vs1.48,p<0.001).CSBMinthelinaclotide
(52.7%vs26.1%inplacebo,p<0.001).Allsecondaryendpoints,werealsosignificantlygreaterinthelinaclotidegroup.Theincidenceofdiarrheawashigherinthelinaclotidegroup(13.0%vs1.1%inplacebogroup.Phase2:Patientsswitchedfromplacebotolinaclotideshowedarapidonsetofresponsewithinthe1stweekforchangeinSBMfrequency,similartothatinpatientswhocontinuedtoreceivelinaclotide.
– Themostcommondrug-relatedadverseeventwasmildorsometimesmoderatediarrhea.• Conclusion: Thisstudysuggeststhatalinaclotidedoseof0.5mg/dayiseffectiveand
safeforCCpatientsinJapan.• Comments:validatetheefficacyandsafetyofhigherdoseoflinaclotideusedin
clinicalpracticeinIBS-CandCCpatients.
SFukudo DDW2018,Tu1627
![Page 13: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/13.jpg)
Responsesofrifaximinre-treatmentinIBS-Dpatientswithrecurrentsymptoms(Target3)
Lembo,Aetal.RepeatTreatmentWithRifaximin isSafeandEffectiveinPatientsWithDiarrhea-predominantIrritableBowelSyndrome.2016;Gastroenterol.
![Page 14: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/14.jpg)
CharacterizationofLong-termRifaximinResponders
• Aim:BLcharacteristicsthatpredictlong–termresponse• Methods: posthocanalysisofaphase3,IBS-Dwhomaintainedresponse
withrepeatrifaximintreatment(Target3).Long-termresponsewasdefinedasa≥30%decreasefrombaselineinmeanweeklypainscoreand≥50%decreasefrombaselineinnumberofdays/weekwithBSStype6or7stoolfor≥2offirst4weekspost-treatmentduringtheprimaryevaluationperiodandwasmaintainedthroughthesecond 4-weekfollow-upphase.
• Abdominalpain(0-10),bloating(0-6),andIBSsymptoms(0-6)• Results: 571observedcase;rifaximin(n=290);placebo(n=281).
– Long-termresponsewasachievedby39(13.4%)rifaximin- and21(7.5%)placebo-treatedpatients(P=0.01).
– long-termrifaximinrespondershadasignificantlygreatermeannumberofdailyBM(4.7vs3.2, P=0.0001)andgreaternumberofdayswithstoolurgency(6.4vs4.8; P=0.0001),greatermeandailybaselineabdominalpain(5.8vs4.4, P=0.0002),bloating(4.5vs3.6, P=0.0001)andIBSsymptoms(4.4vs3.6; P=0.0004).
• Conclusions: IBS-Dpatientswithmoreseveresymptomsappearedmorelikelytomaintainlong-termresponsetoshort-courserifaximin.
• Comments: encouragingresultsgivenpositiveresponsetomoreseverepatients(deltaaffect).The‘long-term”definitionisrelativeshort-term.Postmarketingclinicalexperienceofobservationalcohortwillprovidemoreinformation.
LWeinstocketalDDW2018,Su1190
![Page 15: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/15.jpg)
RifaximinandCDiffInfection• Aim:determinetheimpactofrifaximintreatmentonthe
developmentof Cdifficileinfection• Method:posthocanalysisofaphase3,randomized,double-
blind(DB)placebo-controlled,52-weekstudy(Target3)inadultIBS-Dpatients,rifaximin550mgTIDx2weeks
• Results:n=2357,37patientsexcluded(positiveEIAatBL)– 3patientsdidnothavestoolsamplesatBLwerepositiveatthe
endofstudy(mighthavebeenasymptomaticcarriers).– 1developedCdiff37daysaftercompletionoftreatment(UTI
treatedwithcefdinirx10days• Conclusion:NoreportedCdiffcase
• Comments:consistentwithreportedsafetyprofileinotherstudies(HE)andpost-marketingmonitoringdata
MPimenteletal,DDW2018,Su1195.
![Page 16: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/16.jpg)
Ondansetronimprovesstoolsconsistency,frequencyurgency,andbloating,butnotpain,inIBS-Dpatients
ModifiedandadaptedfromtheROMEIVslidedeck,2016
Garsed etal.Gut2014Oct;63(10):1617-16255-week randomized, double-blind, placebo-controlled crossover study
N=120
Titrateupto8mgTID
![Page 17: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/17.jpg)
OndansetronandIBS-D
Plasse T,BartonGetal.DDW2018.Su1188
Population:Phase2IBS-D,ROMEIIIwithpainintensity≧ 3(10VAS),multicenterUSInterventions:Ondansetron12mgbimodalrelease(BRO,3mgimmediateand9mgextendedrelease)x8weeks,randomized60:40(BROtoplacebo)Endpoints:• stoolconsistencyresponse≧50%reductionindays/wk with≧ 1BMwithBSS6or7cf
baseline;• Painresponse≧ 30%reductionofweeklyavg worsepainoverthepast24hr cf baseline• Compositeresponse:achievestoolconsistencyresponseandpainresponseinthesame
week.
30%male,medianage40yr,medianIBS-D,averageBSS5.8,medianworsepain5,medianCRP2.0mg/L(UNL=5.0mg/L)
Comments:Similaraspreviousstudy,nodataonloperamide(orpreviousmedication)use
![Page 18: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/18.jpg)
TESinCC
• Background:Transabdominalelectricalstimulation(TES)hasshownpromisingresultsinchildrenthatincreasedthecolonictransittimeanddefaecationfrequency,andimproveQoL.
• Method:2tertiaryhospitals,ROMEIII,CC.Rhythm.IC,60mindaily
• Endpoints:PAC-SYM,PAC-QoLatwk 10(for8wktreatmentgroup),atwk 18(16wk Txgroup)cfBL)
NTalley,DDW2018,Mo1538
![Page 19: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/19.jpg)
Rhythm.IC device
Studyprotocol• Battery-operated• ThroughtheabdomenatT10-L3andoverS3-4for60mindaily.• Stimulationusedacarrierfrequencyof4000Hzandmodulationof80-
160Hzatastronglevel(max40mAmps).NTalley,DDW2018,Mo1538
http://www.githerapies.com/technology-product
![Page 20: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/20.jpg)
TESinCC
NTalley,DDW2018,Mo1538
Conclusion:Fromthisinitialpilottrial,Rhythm.IC wouldappeartoprovideavaluableclinicaltherapyforadultssufferingchronicconstipation.
Comments:non-randomized,largeplaceboeffectinFGIpatients,non-standardoutcomesforCCstudies;probablysafe.Costcanbealimitingfactor.
n=17;meanage48.3years,94%female
![Page 21: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/21.jpg)
FMTCinIBS-D
• Aim:investigatedthesafetyandefficacyofFMTc inarandomized,placebo-controlledtrial.
• Methods:multicenter,placebo-controlledRCTinadultmoderate-severeIBS-D.Subjectswererandomized1:1toFMTc followedbyplacebocapsules(Pc)orPcfollowedbyFMTc.– 25FMTc (50gmsofstoolfromahealthydonor)or25Pcandwere
followedfor12weeks.– Allsubjectscrossedoverintothealternatearmat12weeksandwere
followedforanother12weeks.• Outcomes:primary- decreaseinIBS-SSS≥50pointsat12weeks;
Secondary- IBS-QOLscores,HospitalAnxietyandDepressionScale(HADS)scoresandmeanBSSscores.Pre- andpost-interventionstoolsampleswerecollectedinallsubjectsfor16smicrobiomeanalysis.
OCAroniadis etal.DDW2018,OralpresentationNumber:742(mo 16:16-16:32)
![Page 22: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/22.jpg)
• AEswerenotsignificantlydifferentbetweengroups;therewerenoseriousAEs.
• Preliminarymicrobiomeanalysesperformedatbaselinein12of48subjectsdistinguishedFMTrespondersfromnon-responders(AUC=0.93,p=0.09)basedontheabundanceofbacterialspecies,including V.dispar,B.eggerthii,B.uniformis,E.dolichum,B.acidifaciens.
OCAroniadis etal.DDW2018,OralpresentationNumber:742(mo 16:16-16:32)
![Page 23: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/23.jpg)
• Conclusion: FMTc didnotinducesignificantsymptomreliefat12weekscomparedwithplacebo.SubgroupanalysissuggestedthatFMTmaybemoreeffectiveinpatientswithPI-IBS.
FMTCinIBS-D
• Comments:smallsamplesize,48subjectsin3centersbetween2015-2017.Promisingalternatives,certainlymorestudieswillbeperformed,particularlytoidentifytheIBSsub-group,eg post-infectionIBS-D,thatwillmorelikelyrespond.
OCAroniadis etal.DDW2018,OralpresentationNumber:742(mo 16:16-16:32)
![Page 24: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/24.jpg)
MoxibustiononIBS-DMoxibustionisatraditionalacupuncturemethodthatworksbyheatingacupuncturepointswithlightedmoxa
ST-36
![Page 25: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/25.jpg)
MoxibustiononIBS-D• Method:24-weekRCT(6wk treatment,18-wkfollow-up),RomeIIIcriteria,
IBS-D,moxibustion(at43°C± 1°C)vssham(37°C± 1°C),3treatmentsperweekx6weeks.Fouracupoints- ST25(Tianshu,bilateral)andST36(Zusanli,bilateral)
• Outcomes:– Primary:IBSAdequateRelief(IBS-AR)atweek6,week7andweek24,– Secondary:IBS- SSSscores(response>50pt reduction),BSSscore,stool
urgencyassessedatweek6,12,18and24.IBS-QOLwasmeasuredatweek6.• Results:N=104(60.0%F),IBS-ARinmoxibustiongroupwas76.9%vs
42.3%inplacebo(p<0.001)atweek6,remainedsignificantatweek24.IBD– AllsecondaryoutcomesweresignificantlyimprovedexceptIBS-QoLatweek6
• AE:1ineachgrouphadmildscald
• Comments:newpossibletherapeuticoption.GeneralizabilityandMoAneedsfurtherstudy.EfficacyisalsobeingevaluatedinIBD.
LiuH,etal.DDW2018,oralpresentation1025,Tue15:00- 15:30
![Page 26: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/26.jpg)
KeyNewsoutofDDW• Epidemiology
– IBSimposesasignificantfinancialburdeninhealthcareandsociety
– impactsonpolicymakersinresourcesdistribution• Pathogenesis
– StressincreasesIBSoddsandsymptomseverity• Therapies
– MayusehigherdoseoflinaclotideinJapanese(Asian)IBS-Cpatients
– Rifaximin• Additionaldataonbloating,consistentwithclinicalexperience• Noevidenceofincreaseopportunisticinfections(presentation458)orCdiffinposthocanalysis
• ExpectingNoC inDec18andwillbecomeavailableinCanadainspring2019
• Long-termeffects/AEsinrecurrent/chronicusesremainuncertainandwillneedongoingmonitoring.
![Page 27: CARE DDW 2018 LLiu final - CARE™ Education · TCA, SSRI, SNRL antispasmodic Non-Pharmacological e.g. Medication, ... marketing clinical experience of observational cohort will provide](https://reader033.fdocuments.in/reader033/viewer/2022050503/5f9506e696ebaf24470913f5/html5/thumbnails/27.jpg)
Thankyou!
EnjoyWashington,DCandDDW2018!