In a recent supplement in the Journal of Family Practice, the benefit of tegaserod for chronic constipation is overstated.1 I am concerned that this publication is marketing “spin” from the manufacturer of tegaserod, Novartis Pharmaceuticals.
The authors give tegaserod a strength of recommendation rating (SOR) of “A” based on 2 recent studies.2,3 The primary outcome measure used in both studies is percentage of patients labeled “responders” to the medication. A “responder” has a mean increase of >1 complete spontaneous bowel movement (CSBM) per week. Using absolute numbers of “responders,” the number needed to treat with 6 mg bid of tegaserod is 7.2 Additionally, modest gains are noted in numerous constipation symptoms rated by patients on 5-point ordinal scales. Mean increase in CSBM is technically patient-oriented evidence, as are symptoms of constipation, and many of the findings achieve statistical significance compared with placebo. However, I do not believe that most of these differences are clinically significant, and I doubt the value of this expensive medication to most of my patients with chronic constipation.
The supplement is not an unbiased source of clinical information. It is “supported by a grant from Novartis Pharmaceuticals.” Two of the 6 members of the consensus panel receive compensation from Novartis, either as a consultant or as a member of a speakers’ bureau. The 2 referenced trials were funded by Novartis, and all authors of 1 study are either an employee of or a paid consultant to Novartis.2
I am concerned that your journal published this supplement and emphasized the article with a red box labeled “Clinical Update.” The busy clinician is unlikely to recognize this for what it is: pharmaceutical industry marketing.
Steven R. Brown, MD
Banner Good Samaritan Family Practice Residency;
Department of Family and Community Medicine,
University of Arizona School of Medicine