Unscripted – The AMCP Podcast: Transforming Chronic Idiopathic Constipation with a Drug-Free Treatment Solution (Part 1)

Fred Goldstein 0:01 

Welcome to Unscripted. The AMCP podcast, a look inside managed care pharmacy. Listen in as experts explore the challenges, innovations and opportunities shaping healthcare for millions of patients. This episode of Unscripted, the AMCP podcast, is sponsored by Vibrant Gastro Inc., delivering predictable relief from chronic idiopathic constipation (CIC without the side effects and higher cost of prescription medications. This is the first of three episodes. Welcome our guest speakers today. Dr. Christine Frissora is a gastroenterologist and Associate Professor of Clinical Medicine at the New York Presbyterian Cornell University Medical Center. And Dr. Ken Schaecher, Chief Medical Officer emeritus University of Utah health plans, and he is currently an associate medical director at a regional health plan, as well as practicing general internal medicine specialist, they are joining us today to discuss a cost effective breakthrough transforming chronic idiopathic constipation CIC with a drug free treatment solution. Welcome doctors.

Ken Schaecher 1:01 

Thank you. Nice to see you again. 

Fred Goldstein 1:04 

So lets start with you. Dr. Frissora, what is chronic idiopathic constipation? And can you tell us a little bit about the typical patient with this type of disorder, and the estimated prevalence?

Christine Frissora 1:13 

Chronic idiopathic constipation, or CIC, is a disorder in which the patient cannot, definitely cannot, go to the bathroom. As a gastroenterologist, I see patients every day who suffer from constipation, and the constipation can affect many aspects of their life. Can affect their work, because they are afraid to go to the bathroom at work, they're late to work. They can affect their school, their dating life. It can affect their physical sense of well being, because some patients actually have to do something called vaginal sprinting, which means that they have to press on the posterior wall the vagina to get the stool out, which you can imagine stage moralizing. So millions of people in United States suffer from constipation, and two thirds of those patients are women, so they're trying to take care of their children, go to school, go to work, take care of the whole family, and meanwhile, they can't get out of the bathroom, and it's very, very upsetting to them.

Fred Goldstein 2:14 

Is there anything you'd like to add to that, Ken?

Ken Schaecher 2:17 

I think it's important to note that chronic idiopathic constipation is not something that just happens. The standard definition requires that it's been present for at least three months and that other causes have been excluded. And that's what's important to understand, because these patients do go on a significant diagnostic journey sometimes, and they continue on those diagnostic journeys even after the usual testing has been completed, trying to find a solution to a problem that may not have a obvious understanding. And

Fred Goldstein 2:57 

Dr. Frissora, could you discuss the prevalence? How many people are affected by this.

Christine Frissora 3:00 

Constipation affects millions of people in the United States, up to 35 million, and about two thirds of those patients are women.

Fred Goldstein 3:10 

And how about its impact on lifestyle?

Christine Frissora 3:13 

In terms of lifestyle, constipation really has takes a negative toll, because the patients can't get to work on time. They can't get to school on time. They are afraid to date, they're afraid to eat, and they also have a fear that they have cancer. So as our Ken said, we have to do the colonoscopy for many patients, especially once they hit 40, and then make sure that there is nothing structurally wrong, and then we would try to start to treat their constipation without too much unnecessary testing.

Fred Goldstein 3:46 

And are they impacted by other diseases or conditions? 

Christine Frissora 3:50 

Some patients with constipation have up to five other disorders, diabetes and obesity are common comorbid conditions of constipation.

Fred Goldstein 4:00 

And what about the current treatment for CIC? What does that look like?

Christine Frissora 4:04 

Patients take over the counter things to take proto constipation. They might take up to four agents, but they still suffering from incomplete evacuations, training, pushing. And then they take treatments, either over the counter or prescribed treatments, and then they end up with diarrhea and fecal incontinence, and then they're still wearing themselves on the golf course, and it's very demoralizing to them.

Fred Goldstein  4:29 

This episode of Unscripted, the AMCP podcast, is sponsored by Vibrant Gastro, the vibrating capsule for CIC, and back to you, Dr. Frissora, let's continue on. What are some of the side effects that patients experience today with some of the medicines they have to take. 

Christine Frissora 4:42 

Well, some of the prescribed medicines can cause abdominal pain, diarrhea and even fecal incontinence, and you can imagine how much suffering that causes. 

Ken Schaecher 4:52 

So in addition to the comments that Dr. Frissora has made, I'd like to point out that these patients, they on their own. Alone, oftentimes, will seek treatment, and they go to the pharmacy, they will find whatever is on the shelf, and they use things without necessarily consulting their doctors, which can get them in trouble. Yeah, they will use osmotic laxatives, such as MiraLAX, which is pegylated ethylene glycol and similar sort of agents they will use x lacks, which we all know can cause significant problems long term with the ball, so they can get themselves into trouble trying to manage this. And the interesting thing is, they oftentimes, will come and talk it over with their positions as a last straw, they won't want to bring it up. They're somewhat embarrassed by it. This is very similar to other health conditions like overactive bladder, that the prevalence is much more common than physicians think and payers think, because patients are trying to manage it on their own. So you've got stimulants that are used in combination. You've got magnesium containing compounds that are used. These compounds have side effects and problems, and it can cause patients to have other issues that they then don't tell the doctors about it when they go see them for their hypertension, and the doc goes, I don't understand. Why is your magnesium elevated or what have you. So these treatments are themselves, causing some some problems for patients and for provider

Fred Goldstein 6:36 

and Doctor given some of these side effects that were talked about, are there impacts on utilization

Christine Frissora 6:43 

in terms of utilizing therapies? Once patients start having side effects, they do stop treatment often, and sometimes patients say that treatment stopped working. So there's a lot of reasons patients have for stopping therapy,

Fred Goldstein 6:59 

and do we see things like increased Ed utilization, or stuff like that,

Christine Frissora 7:04 

in terms of some of the medications that people use? They do have severe abdominal pain, do have diarrhea, they do have fecal incontinence, and there is a rate of visits to the emergency room, certainly,

Fred Goldstein 7:18 

wow. And when you think about this and the impact on patients and physicians. How do patients and doctors feel about it? They show

Christine Frissora 7:24 

about a 60 or 70% rate of dissatisfaction with treatment. And the same thing for the doctors, the patients that are not happy, the doctors are not happy. And so there is room for new therapy, and there is an unmet clinical need for treating constipation, given this dissatisfaction

Fred Goldstein 7:43 

You've talked about, that's sort of a great segue into this new drug-free solution. Dr. Schaecher, can you share a little bit about that and what's going to go on in our next episode?

Ken Schaecher 7:52 

Thanks, Fred. You know as Dr. Frissora mentioned, there is a lot of dissatisfaction out there, and it there is ripple effects with regards to therapies, patients who are not getting good results from their current therapies, they'll also oftentimes blame because they do have comorbidities, they'll blame the drugs they're taking for their diabetes or their hypertension or their heart disease as causing the problem, and so they'll stop taking those medicines. So you can imagine, with the side effects that can come from, from some of the therapies, from the lack of effectiveness, there is room for a new solution. And what we have today, and what we're going to talk about is a new solution called the vibrant capsule. And you can see it right here. Here's the capsule, here's the activator, and this is a drug free solution to overcome the issues that we see in the management of chronic idiopathic constipation. It works through a mechanism that stimulates the bowel, and we'll go over that at the next episode. It also reduces the side effects. It also is likely more cost cost effective than many of the current prescription drugs that are being offered to treat chronic idiopathic constipation. So a lot to talk about, and we're going to talk about it here in the next episode. Well

Fred Goldstein 9:27 

Thanks so much, Dr. Frissora and Schaecher, for joining us on Unscripted, the AMCP Podcast. I'm really interested in learning more in the next episode, so that'll be fascinating. This episode was sponsored by Vibrant Gastro. Learn more about the drug-free solution at Vibrant Gastro.com