ANI Pharmaceuticals has announced the launch of Prucalopride Tablets, a generic equivalent to Takeda Pharmaceuticals' Motegrity, following FDA approval and a Competitive Generic Therapy (CGT) designation granting 180-day exclusivity. This development offers a new option for adults suffering from chronic idiopathic constipation (CIC). Prucalopride functions as a selective, high-affinity 5-hydroxytryptamine 4 (5-HT4) receptor agonist, stimulating rhythmic colonic movements to alleviate infrequent bowel movements.
Clinical Efficacy and Safety
Clinical trials have affirmed the efficacy and safety of prucalopride in managing chronic constipation. A 2016 study published in Digestive Diseases and Sciences analyzed data from six randomized, double-blind, placebo-controlled Phase 3 and 4 trials. These trials evaluated a 2 mg once-daily dose of prucalopride, with the primary endpoint being the percentage of patients achieving an average of three or more spontaneous complete bowel movements (SCBMs) per week over a 12-week period.
The trials, involving 2484 patients (primarily women), demonstrated that a significantly higher proportion of patients treated with prucalopride achieved the primary endpoint (27.8%) compared to the placebo group (13.2%; OR 2.68 [95% CI, 2.16, 3.33]; p < .001). The safety profile was also favorable, with no significant differences observed between male and female patients.
A systematic review and meta-analysis published in the Journal of Neurogastroenterology and Motility in 2016, encompassing 16 randomized controlled trials and 3943 patients, further supported prucalopride's efficacy. The analysis revealed that prucalopride, at doses of 1 mg, 2 mg, and 4 mg, significantly increased the frequency of spontaneous bowel movements (SBMs) per week.
Real-World Evidence and Adverse Events
Real-world evidence indicates that prucalopride demonstrates higher treatment persistence and adherence compared to other prescription medications for CIC. However, potential adverse events (AEs) should be considered. Common AEs include headache, nausea, dizziness, abdominal pain, gas, fatigue, vomiting, diarrhea, and bloating. Serious AEs, though less frequent, may include depression, mood changes, or suicidal ideation.
In the 2016 clinical research, 63.3% of the prucalopride group and 53.3% of the placebo group experienced at least one treatment-emergent AE (TEAE), with most being mild to moderate. The most common TEAEs in the prucalopride group were gastrointestinal disorders and headache. Cardiovascular-related AEs were rare. The meta-analysis noted more frequent occurrences of headache, abdominal cramps, excessive flatulence, diarrhea, dizziness, and rash in the prucalopride group.
