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Patterns of laxative use for chronic functional constipation in Japanese children: A longitudinal descriptive study
Takenori Akaike1,2, Toshiki Fukasawa1, Takanori Yanai1
1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Insights
Magnesium oxide is the leading laxative for childhood constipation in Japan, with polyethylene glycol (PEG) 4000 now second. PEG 4000's 2019 introduction decreased use of other conventional treatments.
Area of Science:
- Pediatric Gastroenterology
- Pharmacotherapy Research
- Real-world Evidence Studies
Background:
- Chronic functional constipation (CFC) affects many children globally.
- Understanding pharmacotherapy patterns is crucial for effective pediatric constipation management.
- The introduction of polyethylene glycol (PEG) 4000 in Japan in 2019 prompted a shift in treatment strategies.
Purpose of the Study:
- To analyze real-world pharmacotherapy trends for pediatric chronic functional constipation (CFC) in Japan.
- To assess the impact of polyethylene glycol (PEG) 4000 market introduction on laxative prescribing patterns.
- To identify variations in medication use based on patient demographics and clinical factors.
Main Methods:
- A longitudinal descriptive study utilizing a Japanese health insurance claims database.
- Inclusion criteria: children aged 0-14 years with constipation diagnosis and ≥5 days laxative prescription.
- Data analysis included baseline characteristics, 12-month treatment trajectories, and subgroup analyses by sex, age, and institution type.
Main Results:
- Magnesium oxide was the most prescribed laxative (31.0%), followed by PEG 4000 (19.9%) among 166,808 eligible children.
- The introduction of PEG 4000 in 2019 correlated with a decrease in prescriptions for other conventional laxatives.
- Laxative choice varied by age, with PEG 4000, malt extract, and lactulose more common in younger children, and Kampo medicine in older children.
Conclusions:
- Magnesium oxide remains the primary laxative for pediatric CFC in Japan, with PEG 4000 as the second most common.
- The availability of PEG 4000 has led to reduced reliance on older conventional laxatives.
- Findings support personalized pharmacotherapy approaches for childhood constipation in clinical practice.
Background:
To characterize real-world pharmacotherapy patterns among Japanese children with chronic functional constipation (CFC), with particular attention to changes after the market introduction of polyethylene glycol (PEG) 4000 in 2019.
Methods:
This longitudinal descriptive study was conducted using a Japanese health insurance claims database. We identified children aged 0-14 years who had an outpatient claim with a constipation diagnosis and received an initial prescription for laxatives lasting ≥5 days at the same visit between 2012 and 2022. We described baseline characteristics and laxative treatment trajectories throughout a 12-month follow-up. Subgroup analyses were performed by sex, age, and institution type.
Results:
Among 166,808 eligible children, 64.1% entered the cohort after 2019. Mean age was 4.0 years and 56.6% were female. Magnesium oxide was the most commonly used laxative (31.0%), followed by PEG 4000 (19.9%). Introduction of PEG 4000 in 2019 was accompanied by a decline in prescriptions for other conventional agents. Medication choices varied by age: magnesium oxide was predominant across all age groups; PEG 4000, malt extract, and lactulose were more commonly used in younger children; and traditional Japanese Kampo medicine was favored in older children.
Conclusions:
Magnesium oxide remains the most frequently prescribed laxative for pediatric CFC in Japan, with PEG 4000 now ranking second. The introduction of PEG 4000 in 2019 reduced reliance on other conventional laxatives. These findings may help clinicians tailor pharmacotherapy for childhood constipation.
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