NICE approves lubiprostone for chronic constipation and revises prasugrel guidance

NICE has approved lubiprostone for the treatment of chronic idiopathic constipation and has also revised its guidance on the use of prasugrel for the prevention of atherosclerotic events in people with acute coronary syndromes.

Lubiprostone activates chloride channels to increase intestinal fluid secretion, increasing intestinal motility.
Lubiprostone activates chloride channels to increase intestinal fluid secretion, increasing intestinal motility.

Lubiprostone (Amitiza), the first in a new class of treatments for chronic idiopathic constipation, was launched in the UK last year. It is indicated for the treatment of chronic idiopathic constipation and associated symptoms in adults, when the response to diet and other non-pharmacological interventions (eg, educational measures and physical activity) is inadequate.

NICE recommends lubiprostone as an option for treating chronic idiopathic constipation in adults who have had an inadequate response to at least two laxatives from different classes at the highest tolerated doses for at least six months and for whom invasive treatment for constipation is being considered.

The guidance also states that if treatment with lubiprostone is not effective after two weeks the person should be re-examined and the benefit of continuing treatment reconsidered. The drug should only be prescribed by clinicians with experience of treating chronic idiopathic constipation who have carefully reviewed the person's previous courses of laxative treatment.

NICE guidance on lubiprostone for treating chronic idiopathic constipation (TA318)

NICE revises prasugrel guidance

NICE has revised its guidance on Eli Lilly's antiplatelet agent prasugrel (Efient), approving its use in a wider group of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).

The original guidance (TA182), published in 2009, recommended prasugrel for use in ACS patients with ST-segment elevation myocardial infarction (STEMI), those who had experienced stent thrombosis during clopidogrel treatment, and those with diabetes mellitus. The revised guidance extends the group of patients eligible for treatment with the drug to include those with unstable angina or non-STEMI, stating that prasugrel 10mg in combination with aspirin is recommended as an option for preventing atherothrombotic events in adults with ACS undergoing primary or delayed PCI.

NICE guidance on prasugrel for treating acute coronary syndromes (TA317)

Other new NICE guidance

Other NICE guidance published this month approves the use of ipilimumab (Yervoy) for previously untreated advanced melanoma (TA319) and the use of enzalutamide (Xtandi) for metastatic hormone-relapsed prostate cancer (TA316).

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