Thématique :
- Intestin/Nutrition/Troubles fonctionnels
Originalité :
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Pas encore
Nom du veilleur :
Docteur Pauline JOUET
Coup de coeur :
  2016 Aug 12. pii: S0016-5085(16)34926-5  
  doi: 10.1053/j.gastro.2016.08.003  
  Repeat Treatment With Rifaximin is Safe and Effective in Patients With Diarrhea-predominant Irritable Bowel Syndrome  
  Lembo A, Pimentel M, Rao SS, Schoenfeld P, Cash B, Weinstock LB, Paterson C, Bortey E, Forbes WP  


Few treatments have demonstrated efficacy and safety for diarrhea-predominant irritable bowel syndrome (IBS-D). A phase 3, randomized, double-blind, placebo-controlled trial was performed to evaluate the safety and efficacy of repeat treatment with the nonsystemic antibiotic rifaximin.


The trial included adults with IBS-D, mean abdominal pain and bloating scores of 3 or more, and loose stool, located at 270 centers in the United States and Europe from February 2012 through June 2014. Those responding to a 2 week course of open-label rifaximin 550 mg 3 times daily who then relapsed during an observation phase (up to 18 weeks) were randomly assigned to groups given repeat treatments of rifaximin 550 mg or placebo, 3 times daily for 2 weeks. The primary endpoint was percentage of responders after first repeat treatment, defined as a decrease in abdominal pain of 30% or more from baseline and a decrease in frequency of loose stools of 50% or more from baseline, for 2 or more weeks during a 4-week posttreatment period.


Of 1074 patients (44.1%) who responded to open-label rifaximin, 382 (35.6%) did not relapse, whereas 692 (64.4%) did; of these, 636 were randomly assigned to receive repeat treatment with rifaximin (n=328) or placebo (n=308). The percentage of responders was significantly greater with rifaximin than placebo (38.1% vs 31.5%, P=.03). The percentage of responders for abdominal pain (50.6% vs 42.2%, P=.018) was significantly greater with rifaximin than placebo, but not stool consistency (51.8% vs 50.0%, P=.42). Significant improvements were also noted for prevention of recurrence, durable response, and bowel movement urgency. Adverse event rates were low and similar between groups.


In a phase 3 study of patients with relapsing symptoms of IBS-D, repeat rifaximin treatment was efficacious and well tolerated.

Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

Question posée
Quel est l’effet d’un retraitement par rifaximine chez des patients ayant un SII-D et ayant rechuté après une réponse à un premier traitement ?
Question posée
Dans une étude randomisée de phase III effectuée chez 636 patients IBS-D ayant répondu puis rechuté après un premier traitement par rifaximine, la réponse au retraitement par rifaximine (550mg trois fois par jour pendant 14j) en comparaison à un placebo était significativement plus importante (38.1% vs 31.5%, P=.03) ainsi que l’effet sur les douleurs abdominales, l’effet sur la consistance des selles et les ballonnements n’étaient pas différents.

L’effet du retraitement par rifaximine est significatif mais avec une différence minime de 7% par rapport au placebo : ces résultats méritent d’être confirmés !