In January 2018, plecanatide (Trulance®), developed by Synergy Pharmaceuticals, received approval for the treatment of adult patients with irritable bowel syndrome with constipation (IBS-C). This is the second indication for the agent and comes a year after its first global approval in the US for the treatment of adults with chronic idiopathic constipation (CIC).
Plecanatide is an oral, once-daily medication that can be taken at any time of the day, with or without food. The agent is designed, with the exception of a single amino acid substitution to provide greater binding affinity, to be structurally identical to human uroguanylin; it is thought to replicate the pH-sensitive activity of natural uroguanylin. 
It is hoped that this convenient dosing regimen will provide much needed aid to the large number of patients living with IBS-C that have been described by William D. Chey, M.D., Professor of Medicine, Director of the GI Physiology Laboratory, and Co-Director of the Michigan Bowel Control Program at the University of Michigan as “not satisfied with currently available treatment options.” 
“With this second indication for TRULANCE,” he said, “patients and physicians will have a much-needed, new treatment option with an established safety profile that can effectively address abdominal pain and constipation experienced by patients with IBS-C.” 
The safety of plecanatide in patients under 18 years has not been established, and it’s use in patients less than 6 years is contraindicated based on a risk of serious dehydration, concluded from observations made in preclinical trails in rodents.
The recent first global approval of plecanatide has been reviewed in detail in the First Global Approval report in Adis’ journal Drugs, based on the development milestones tracked in AdisInsight.
Image credit: Tim Gouw