Gut
Which IBS patients are most likely to benefit from amitriptyline?
Amitriptyline may be a viable second-line treatment for irritable bowel syndrome (IBS), particularly in older adults, men, and those with IBS diarrhea.
Study details: The AmitripTyline at Low-dose ANd Titrated for Irritable bowel syndrome as Second-line treatment (ATLANTIS) study randomized 463 adults with IBS to either low-dose amitriptyline (232) or placebo (231) for six months. Post hoc analyses were conducted to identify predictors of response and tolerability based on baseline demographic and disease-related characteristics.
Results: Amitriptyline was more effective in patients aged ≥50 years, with a mean difference in IBS severity scoring system (IBS-SSS) of −46.5 (95% CI −74.2 to −18.8, p=0.0010) and an odds ratio (OR) for subjective global assessment of relief of 2.59 (95% CI 1.47-4.55, p=0.0010). Patients from the most deprived areas of England showed a ≥30% improvement in abdominal pain with an OR of 2.70 (95% CI 1.52-4.77, p=0.0007). Men and those with IBS with diarrhea also experienced significant benefits. Side effects were similar across most IBS subtypes.
Source:
Wright-Hughes A, et al. (2025, January 25). Gut. Predictors of response to low-dose amitriptyline for irritable bowel syndrome and efficacy and tolerability according to subtype: post hoc analyses from the ATLANTIS trial. https://pubmed.ncbi.nlm.nih.gov/39863398/