elobixibat (BixiBat)

Repurposing Elobixibat for Genetic Cholestasis.

Ravindranath Aathira A, Wadhwa Rajkumar P RP

Exploring the Treatment Outcomes and Safety of Elobixibat for Chronic Constipation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Liberty Maggie M, Sungkar Taufik T, Liberty Peggy P

Currently available laxatives usage in chronic constipation (CC) has been reported to cause various adverse events, notably melanosis coli and colonic neuromuscular disorder. Elobixibat, an ileal bile acid transporter inhibitor, appears to be a promising option for chronic constipation to counteract this challenge. This study aims to evaluate the treatment outcome and safety of elobixibat for chronic constipation. This systematic review and meta-analysis were performed on 3 search engines: PubMed/MEDLINE, ScienceDirect, and Cochrane Database of Systematic Reviews. Randomized controlled trials (RCTs) comparing elobixibat 10 mg with placebo in patients with functional chronic constipation were included. The quality of studies was assessed using the Cochrane risk of bias 2.0 tool. Statistical analyses were conducted using RevMan 5.4.1 software. A total of six RCTs that met the inclusion criteria were included in this study. Results demonstrated that elobixibat markedly improved bowel movement with a significant change in spontaneous bowel movement (SBM) (MD 2.91, 95% CI 2.81 to 3.01, p<0.00001) and complete spontaneous bowel movement (MD 0.61, 95% CI 0.38 to 0.83, p<0.00001). The percentage of patients experiencing first SBM in 24 hours was significantly higher in the elobixibat group compared to the placebo group (RR 1.49, 95% CI 1.21 to 1.84, p=0.0002). Stool consistency was improved significantly in the elobixibat group (MD 1.40, 95% CI 1.09 to 1.71, p<0.00001). Moreover, the elobixibat group reported favourable safety with no serious adverse events. Elobixibat shows promising therapeutic efficacy in the treatment of functional chronic constipation. Elobixibat is safe and well-tolerated with minimal adverse events.

Targeted Ileal Bile Acid Transporter Inhibition as Rescue Therapy for Tirzepatide-Induced Severe Constipation: A Case Report.

Choudhuri Bodhisatwa B

Constipation is a common, dose-dependent adverse effect of incretin-based anti-obesity therapies that affects patient adherence and may necessitate discontinuation, resulting in loss of metabolic benefits and weight regain. Elobixibat, an ileal bile acid transporter (IBAT) inhibitor, may offer a targeted alternative when conventional laxatives fail. A 56-year-old woman with obesity (95 kg; BMI 38.5 kg/m2) developed severe constipation after increasing tirzepatide to 10 mg weekly. Her bowel movements decreased from 6 to 8 times weekly (Bristol Stool Chart types 3-5) to 2-3 times weekly (types 1-2), with worst symptoms 2-3 days post-injection. Lactulose, psyllium, stimulant laxatives, and polyethylene glycol were ineffective or poorly tolerated, leading to painful perianal fissures. Tests showed hypertriglyceridemia and mild transaminitis with no obstruction on imaging. Elobixibat was started at 10 mg daily before dinner with continued tirzepatide. Bowel movement occurred 20 h after the administration. Stool frequency improved to 5-6 times weekly initially and 9-10 times weekly in the second week. Transient loose stools resolved after reducing elobixibat to 5 mg daily. By week three, bowel movements normalized to 7-8 times weekly (types 3-5) with improved defecation and resolved perianal symptoms. No serious adverse events were observed. Elobixibat provided effective relief, enabling the continuation of tirzepatide therapy. Therefore, a prospective evaluation is recommended. IBAT inhibition may represent a mechanism-based strategy to overcome the specific motility deficits induced by incretin therapy.

Feasibility and tolerability of reduced-volume oral sulfate solution combined with elobixibat for bowel preparation before colonoscopy: a single-center pilot study.

Murakami Takashi T, Ito Kentaro K, Kamba Eiji E, Tsugawa Naoki N et al.

Reducing the volume of bowel preparation may improve patient adherence and tolerability without compromising cleansing efficacy. Oral sulfate solution (OSS) is a low-volume preparation option, and elobixibat, a bile acid transporter inhibitor, may enhance colonic secretion and motility. We evaluated the feasibility, efficacy, safety, and tolerability of a same-day regimen combining elobixibat with OSS. This prospective single-arm pilot study was conducted at Juntendo University Hospital in Japan. Consecutive patients aged 20-64 years scheduled for elective colonoscopy were enrolled between April 2021 and March 2023. Patients received elobixibat (10 mg once daily for 3 days before colonoscopy), followed by same-day OSS using a "stop-when-clear" protocol. The primary outcome was adequate bowel preparation, defined as a total Boston Bowel Preparation Scale (BBPS) score ≥6. Secondary outcomes included OSS volume consumed, adverse events, and patient-reported tolerability assessed by questionnaire. Twenty-eight patients were analyzed. Adequate bowel preparation was achieved in 96% of patients. BBPS ≥2 were 82% in the right colon, 96% in the transverse colon, and 100% in the left colon. The mean total OSS volume was 771 mL, and 57% of patients completed preparation with ≤720 mL. No serious adverse events were observed. Most patients reported acceptable palatability (82%) and manageable volume (100%). Among those with prior colonoscopy experience, 75% preferred this regimen and 86% indicated willingness to use it again. A same-day regimen combining elobixibat with OSS demonstrated favorable feasibility, efficacy, and tolerability. Reduced OSS volume may be achievable in selected patients. However, these findings are limited to a relatively low-risk, non-elderly population and should be confirmed in larger comparative studies.