Treatment Patterns, Over-the-Counter (OTC) Use, and Outcomes Among Patients With Irritable Bowel Syndrome With Constipation or Chronic Idiopathic Constipation: Results from the CONTOR Study

Abstract

Introduction: Understanding how patients with irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC) treat their disease and what drives treatment satisfaction or discontinuation is important when considering new treatment options. Treatment choice may be difficult, due in part to the heterogeneity and/or severity of these disorders. This analysis of the Chronic Constipation and IBS-C Treatment and Outcomes Real-world Research Platform (CONTOR) study examined treatment patterns and outcomes among participants with IBS-C or CIC. Methods: CONTOR included fully insured US patients with: both medical and pharmacy benefits and ≥1 medical claim for constipation (ICD-9-CM diagnosis code: 564.0x); or ≥1 claim for IBS (564.1x) or abdominal pain (789.0x) plus ≥1 pharmacy claim for a stool softener/laxative; or ≥1 claim for linaclotide or lubiprostone (October 2014 to November 2016). Over the 12-month study period, participants completed a baseline and quarterly survey, which included the Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire and an assessment of overall treatment satisfaction. Monthly surveys collected patient-reported new or discontinued IBS-C/CIC treatments. Association between quality of life and changes in treatment satisfaction was determined by multivariate analyses. Results: Of 2052 CONTOR participants, 93.8% (n=1922) were female; the mean (SD) age was 46.7 (11.9) years. At baseline, the majority of participants reported their IBS-C/CIC treatment included over-the-counter (OTC) medication use (65.4%), while 22.2% reported OTC and prescription treatment (Table 1). The concomitant use of prescription and OTC treatments remained consistent over the study period. The most common reasons for discontinuing any treatment were failure to improve constipation (41.4%), bloating (39.4%), and pain (34.7%); improved symptoms no longer required medication in 28.7% of participants. The odds of becoming satisfied with treatment were higher in participants with improved PACQOL total scores (defined as ≥0.5 improvement from baseline) compared to those with no improvement (p<0.001) (Table 2). Conclusion: The majority of participants with IBS-C or CIC used a variety of treatments to manage their disease. Improved quality of life was associated with treatment satisfaction.423_A Figure 1. Patient-reported baseline medication use423_B Figure 2. Multivariate logistic regression analysis of treatment satisfaction adjusted for PAC-QOL total score, treatment, and baseline characteristics