Definitely too early to presume first in class. The competition between plecanatide and linaclotide may be a prescriber's preference type situation. If we're being generous to both sides, right now linaclotide may have a small hint of an efficacy edge while plecanatide has an edge in side effect / AE profile
Around 20% of Linzess patients experience diarrhea, which is far greater than the 5.9% and 5.5% incidence rates reported in the Phase 3 patients taking the 3 mg or 6 mg dose of plecanatide. In light of the fact diarrhea and associated abdominal pain are the primary reasons many patients are discontinuing usage of Linzess, I think plecanatide will quickly become the treatment of first resort once it enters the marketplace.