Trulance® – A New Treatment for Adults with Irritable Bowel Syndrome with Constipation

Drug Review: Volume 22, Issue 6

Irritable bowel syndrome with constipation (IBS-C) is a chronic disorder characterized by abdominal pain, bloating, and altered bowel habits, such as bowel movements consisting of mostly hard or lumpy stools, but also, on occasion, loose or watery stools. It is estimated that there are 1.7 million Canadians living with IBS, of which over 25% have IBS-C. This disorder typically impacts people of working-age, contributing up to 1.7 absent days per month of work or school. Canadians diagnosed with IBS-C have increased incidence of depression, stress, and anxiety, as well as an overall lower quality of life.

Patients with IBS-C are treated with the goal of managing symptoms, reducing health care visits, and improving quality of life. The current treatment guidelines for IBS-C recommend improving diet, increasing fibre intake, and using oral laxatives. For patients with persistent symptoms of IBS-C despite these treatment modalities, a guanylate cyclase-C (GC-C) agonist, such as Constella, is recommended. Ibsrela has also been approved by Health Canada for the treatment of IBS-C. However, current drug therapies show high rates of adverse reactions such as diarrhea. Therefore, there is need for safer and more effective treatment options for IBS-C.

Trulance^® (plecanatide) is a GC-C agonist that has been shown to effectively manage all symptoms associated with IBS-C. Trulance^® is administered orally and dosed once daily, with a recommended dose of 3 mg. Research has shown that patients receiving Trulance^® reported greater reduction of abdominal pain and more complete spontaneous bowel movements compared to placebo. While there are still low rates of adverse effects, such as diarrhea, significantly more patients were satisfied and willing to continue treatment with Trulance^® compared to placebo.

Trulance^® is within the same price range as Constella and Ibsrela, however is priced at premium compared to oral laxatives available over the counter. As a safe and effective treatment option for IBS-C, Trulance^® is covered under Special Authorization for ClaimSecure groups subscribed to Managed Formularies. Trulance^® will be fully covered for groups subscribing to Open Formularies.