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Primary Endpoints for Irritable Bowel Syndrome Trials: A Review of Performance of Endpoints

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By M Camilleri, et al. • • April 20, 2007

[Note: Clinical trial endpoints are definitions of target outcomes.]

Journal: Clinical Gastroenterology and Hepatology. 2007 Apr 10;

Authors and affiliation: Camilleri M, Mangel AW, Fehnel SE, Drossman DA, Mayer EA, Talley NJ. CENTER Program, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota.

PMID: 17428741

The choice of primary endpoint for a clinical trial is one of the most important determinants of the ability of a clinical trial to demonstrate efficacy of therapeutic agents. Although there are still no clear, universally accepted guidelines on the definition of clinical benefit for irritable bowel syndrome (IBS), consensus guidelines stress the importance of using validated endpoints.

This article reviews the evidence available in the literature on the psychometric validation and performance of the 3 endpoints recommended by the Rome III Committee for use as primary endpoints in treatment trials of IBS. [The Rome III Committee collects and publishes information “for the evaluation and care of patients having functional gastrointestinal disorders.”]

The Rome III Committee recommends 2 types of measures: binary endpoints addressing the construct of relief (that is, adequate relief and satisfactory relief) and an integrative symptom questionnaire that addresses the change in severity of a representative group of symptoms of IBS (that is, the IBS Severity Scale).

The current evidence suggests that at present, adequate relief should be recognized by regulatory authorities as an acceptable primary endpoint in clinical trials.

This analysis also suggests that data from individual clinical trials should be pooled and undergo meta-analysis, and that prospective studies should be considered to further characterize the performance of available endpoints as outcome measures in pharmacotherapeutic trials in IBS.

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