ACG, AGA guideline first to recommend magnesium oxide, senna for chronic constipation
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Key takeaways:
- ACG and AGA recommend polyethylene glycol, sodium picosulfate, linaclotide, plecanatide and prucalopride for chronic constipation management.
- Prior authorization may still be needed for additional pharmacologic therapies.
The ACG and AGA have released a joint clinical practice guideline with 10 evidence-based recommendations for the pharmacological management of adults with chronic idiopathic constipation, the first to include magnesium oxide and senna.
The expert panel made strong recommendations for the use of polyethylene glycol, sodium picosulfate, linaclotide, plecanatide and prucalopride, while conditional recommendations were made for fiber, lactulose, senna, magnesium oxide and lubiprostone.
“The guidelines are meant to provide a framework for approaching the management of [chronic idiopathic constipation],” Lin Chang, MD, AGAF, FACG, guideline author and vice chief of the Vatche and Tamar Manoukian Division of Digestive Diseases at the David Geffen School of Medicine at the University of California, Los Angeles, said in a related release. “Clinical providers should engage in shared decision-making based on patient preferences as well as medication cost and availability.”
The multidisciplinary panel conducted systematic reviews of fiber, osmotic laxatives, stimulant laxatives, sodium picosulfate, secretagogues and a serotonin type 4 agonist and used the Grading of Recommendations Assessment, Development and Evaluation framework to evaluate evidence for each therapeutic.
The recommendations balance desirable vs. undesirable effects, patient values, costs and health equity considerations. Highlights include:
- The use of fiber supplementation, polyethylene glycol, magnesium oxide or senna over management without.
- The use of bisacodyl or sodium picosulphate short-term or as a rescue therapy over management without.
- The use of lactulose over management without in those who fail or are intolerant to over-the-counter therapies.
- The use of lubiprostone, linaclotide, plecanatide or prucalopride over management without in those who do not respond to OTC therapies.
“Most of the medications assessed in this guideline are readily available; however, some of them are still available only in brand name formulations because generic formulations do not exist,” William D. Chey, MD, AGAF, FACG, H. Marvin Pollard Professor of Gastroenterology and chief of the division of gastroenterology and hepatology at Michigan Medicine and also a guideline author, said in the release. “As a result, it is important to consider the out-of-pocket expenses for patients that may depend on prescription coverage with various insurance plans. Prior authorization might be required for some of the medications.”
Reference:
- ACG and AGA guideline on chronic constipation management is first to recommend supplements magnesium oxide and senna as evidence-based treatments. https://webfiles.gi.org/links/media/AGA_ACG_Chronic_Constipation_Guideline_Media_Statement_05192023_FINAL.pdf. Published May 19, 2023. Accessed May 19, 2023.
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