Elobixibat Treatment for Chronic Constipation

Introduction to Guidelines

• The American Gastroenterological Association-American College of Gastroenterology does not recommend elobixibat as a first-line treatment option for chronic constipation in the United States 1, 2, 3

Treatment Algorithm for Chronic Constipation

• The American Gastroenterological Association-American College of Gastroenterology recommends polyethylene glycol (PEG) as a first-line option for chronic constipation treatment, with strong recommendation and moderate certainty evidence 4
• The American Gastroenterological Association-American College of Gastroenterology recommends bisacodyl or sodium picosulfate for short-term or rescue therapy, with strong recommendation and moderate certainty evidence 5
• The American Gastroenterological Association-American College of Gastroenterology recommends linaclotide as a second-line option for patients who don't respond to first-line treatments, with strong recommendation and moderate certainty evidence 6
• The American Gastroenterological Association-American College of Gastroenterology recommends plecanatide as a second-line option for patients who don't respond to first-line treatments, with strong recommendation and moderate certainty evidence 7
• The American Gastroenterological Association-American College of Gastroenterology recommends prucalopride as a second-line option for patients who don't respond to first-line treatments, with strong recommendation and moderate certainty evidence 8
• The American Gastroenterological Association-American College of Gastroenterology conditionally recommends magnesium oxide for chronic constipation treatment, with conditional recommendation and very low certainty evidence 4
• The American Gastroenterological Association-American College of Gastroenterology conditionally recommends lactulose for chronic constipation treatment, with conditional recommendation and very low certainty evidence 4
• The American Gastroenterological Association-American College of Gastroenterology conditionally recommends senna for chronic constipation treatment, with conditional recommendation and low certainty evidence 9
• The American Gastroenterological Association-American College of Gastroenterology conditionally recommends lubiprostone for chronic constipation treatment, with conditional recommendation and low certainty evidence 10

AGA‑ACG Guideline Position on Elobixibat for Chronic Constipation

Guideline Exclusion of Elobixibat

• The 2023 joint American Gastroenterological Association–American College of Gastroenterology (AGA‑ACG) clinical practice guideline does not list elobixibat among its ten evidence‑based pharmacologic recommendations for chronic idiopathic constipation. 11, 12
• The guideline panel performed systematic reviews of multiple agents but did not evaluate elobixibat, indicating it is not part of the standard U.S. treatment algorithm for chronic constipation. 11

First‑Line Pharmacologic Recommendation (PEG)

• Polyethylene glycol (PEG) 17 g daily is strongly recommended as the first‑line therapy for chronic constipation, supported by moderate‑certainty evidence. 11

Rationale for Elobixibat’s Absence in U.S. Guidelines

• The 2023 AGA‑ACG guideline prioritized agents with established efficacy data in U.S. populations and FDA approval; elobixibat’s clinical development has been primarily in Japan and it lacks FDA approval for use in the United States. 11, 12