Clinical Evidence of Peristeen® for the Treatment of Neurogenic Bowel
Dysfunction in Multiple Sclerosis
Introduction
Multiple sclerosis (MS) is an immune-mediated inflammatory and progressive central neurologic disease, affecting bothbrain and spinal cord, but also causing bowel disturbance (most often chronic constipation (CC) and fecal incontinence(FI)), known as neurogenic bowel dysfunction (NBD) in over two-thirds of patients1.
Management of NBD in MS patients is empirical and published outcomes with conservative therapy remain variable. Twoclinical studies have investigated outcome, safety and predictive factors of success with transanal irrigation (TAI) withPeristeen in a population of MS patients.

Clinical studies overview
Study nameStudy design
Intervention
Pathology
Study size
Timeline
Primary endpoints
Methods

Conclusion

Preziosi et al 20122
Prospective observational
Peristeen TAI
MS
30 adults
6 weeks
Wexner-Constipation score (0-30, with 30 being most severe)and Wexner-Incontinence score (0-20, with 20 being mostsevere)
Patients were asked to fill out questionnaire at baseline and 6weeks posttreatment.
Patients with >50% improvement in bowel scores wereconsidered responders.

Passananti et al 20163
Prospective observational
Peristeen TAIMS
49 adults
4 years (minimum follow-up of 1 year)
NBD score (0-47, with 47 being most severe) and EQ-5D(quality of life assessment)

TAI is effective to treat bowel symptoms in patients with multiple
sclerosis.

TAI is an effective long-term treatment for MS patients withNBD. It also reduces the use of other healthcare services,such as hospitalizations and visits to the general practitioner.

Predominant symptoms, reason for beginning TAI and
medical comorbidity were investigated. All patients
underwent anorectal physiology testing. They completed
NBD and EQ-5D questionnaires at baseline and annual
follow-up.

Results

Top left: Comparison between pre- and post-treatment of WexnerConstipation and Incontinence scores. Significant reduction in bothscores after 6 weeks treatment with Peristeen was observed.
Top right: Kaplan-Meier plot showing patient discontinuation ofPeristeen therapy over 1 year. Majority of discontinuations (36.7 %)happened within first 6 months.
Bottom left: NBD score at baseline and at latest follow-up after starting
Peristeen. There is a significant shift towards less severe NBD at thefollow-up after Peristeen treatment.

Conclusion
Both studies observe an improvement in bowel symptoms both short-term and long-term, demonstrating that TAI is aneffective treatment for MS patients with NBD.
1. Chia, Y. W. et al. Prevalence of bowel dysfunction in patients with multiple sclerosis and bladder dysfunction. J. Neurol. 242, 105–108 (1995).
2. Preziosi, G. et al. Transanal Irrigation for Bowel Symptoms in Patients with Multiple Sclerosis. Dis. Colon Rectum 55, 1–8 (2012).
3. Passananti, V., Wilton, A., Preziosi, G., Storrie, J. B. & Emmanuel, A. Long-term efficacy and safety of transanal irrigation in multiple sclerosis. Neurogastroenterol. Motil.
(2016). doi:10.1111/nmo.12833

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