Drugs of the future for diarrhea-predominant irritable bowel syndrome: an overview of current investigational drugs

ABSTRACT

Introduction

Irritable bowel syndrome (IBS) has a significant impact on society and quality of life. Current treatments are ineffective, and new investigational drugs are necessary.

Areas covered

Numerous potential therapies are developing, targeting different areas such as cannabinoid signaling, opioid receptors, tachykinin (NK2) receptors, β3-adrenergic receptors, intestinal microbiota, inflammation, and 5HT receptors. Clinical trial evidence has shown that loperamide, eluxadoline, alosetron, ramosetron, bile acid sequestrants, and rifaximin can modulate GI alterations and benefit patients with IBS-D. Among the potential therapies, ibodutant, ibudilast, blautix, BOS-589, solabegron, vibegron, olorinab, ebastine, and ORP-101 have demonstrated possible effects but remain confirmed.

Expert opinion

Individuals with IBS-D require cost-effective treatment options that do not impede their productivity or that of their caregivers. This is necessary for consistent healthcare and improved quality of life. Therefore, we should focus on developing new, efficient, and affordable medications for IBS-D. The government, insurers, and society must recognize this need and collaborate to ensure its fulfillment.

KEYWORDS:

• Clinical
• diarrhea
• investigational drugs
• irritable bowel syndrome
• opioid receptors
• tachykinin

Article highlights

• IBS is a complex condition that affects the central and peripheral nervous systems due to multiple factors.

• Treating IBS-D patients can be effectively approached by addressing the underlying causes.

• Currently, several potential therapies are under evaluation, including ibudutant, blautix, solabegron, vibegron, olorinab, ebastine, and BOS-589 and ORP-101.

• Pooled data analysis of randomized clinical trials showed that mesalazine significantly alleviates symptoms of IBS-D compared to a placebo.

• Based on clinical trials, rifaximin has an NNT of 10.5 and moderate evidence supporting its use.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.