Black CJ, et al. - The researchers carried out a systematic review and network meta-analysis to evaluate the effectiveness of secretagogues in adults with irritable bowel syndrome with constipation (IBS-C) via searching MEDLINE, EMBASE, EMBASE Classic, and the Cochrane central register of controlled trials through June 2018. They found all drugs (linaclotide, lubiprostone, plecanatide, and tenapanor) to be superior to placebo in a network analysis of randomized controlled trials of secretagogues for IBS-C. For most endpoints, efficacy was similar among individual drugs and dosages. It was noted that diarrhea was significantly more common with all drugs, except lubiprostone (8 mcg, twice daily). Among patients who received lubiprostone, nausea was significantly more common.