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Kvarstein G, Kindlundh-Högberg AM, Ould Setti M, Namane R, Muzwidzwa R, Richter H, Hakkarainen KM. An observational post-authorization safety study (PASS) of naloxegol drug utilization in four European countries. Pharmacoepidemiol Drug Saf 2024; 33:e5710. [PMID: 37969030 DOI: 10.1002/pds.5710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/01/2023] [Accepted: 09/22/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE Naloxegol has been shown to be an efficient alternative to treat opioid-induced constipation (OIC). This study aimed at describing the characteristics of naloxegol users and assessing patterns of naloxegol use and associated factors. METHODS This drug utilization cohort study used observational registry data on patients newly prescribed naloxegol in four European countries. Patient characteristics and patterns of naloxegol use and associated factors were described. RESULTS A total of 17 254 naloxegol users were identified across the countries. Their median age was 56-71 years, and each country had a majority of women (ranging 57.5%-62.9%). Multiple comorbidities, including cancer, were common. Natural opium alkaloids and osmotically acting laxatives (excluding saline) were the most frequently used opioids and laxatives. Overall prior use of opioids ranged from 91.9% to 99.6% and overall prior use of laxatives ranged from 69.9% to 92.4%. Up to 77.7% had prior use of medications with interaction potential, and up to 44.5% used them concurrently with naloxegol. Naloxegol was discontinued by 55.1%-90.9% of users, typically during the first 30 days. Approximately 10%-30% switched to or augmented the treatment with another constipation medication or restarted naloxegol after discontinuation. Augmentation with another constipation medication was relatively common, suggesting that naloxegol was used for multifactorial constipation. CONCLUSION The present study reflects real-world clinical use of naloxegol, including in vulnerable patient groups. Some naloxegol users lacked laxative or regular opioid use within six months before index date or used naloxegol concomitantly with medications presenting an interaction potential.
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Affiliation(s)
- Gunnvald Kvarstein
- Institute for Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | | | - Mounir Ould Setti
- Global Database Studies, Real World Solutions, IQVIA, Espoo, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Rafik Namane
- Kyowa Kirin International plc, Galabank Business Park, Galashiels, UK
| | | | - Hartmut Richter
- Epidemiology, Real World Solutions, IQVIA, Frankfurt/Main, Germany
| | - Katja M Hakkarainen
- Global Database Studies, Real World Solutions, IQVIA, Mölndal, Sweden
- Epidemiology & Real-World Science, RWE Scientific Affairs, Parexel International, Gothenburg, Sweden
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Rizwan MZ, Garcia R, Mara K, Nei S. Evaluating the Safety and Efficacy of Naloxegol in Critically Ill Opioid-Induced Constipation Patients. Cureus 2023; 15:e41422. [PMID: 37546147 PMCID: PMC10403335 DOI: 10.7759/cureus.41422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Opioid-induced constipation (OIC) has become more common in the intensive care unit (ICU) due to increased opioid utilization. Traditional laxatives often prove ineffective against OIC, leading to the increased utilization of naloxegol. However, further research is needed to confirm naloxegol's effectiveness and safety in critical care. This study aimed to explore the safety and efficacy of this intervention in critically ill OIC patients. Methods A single-center retrospective study was conducted on 353 patients who received one or more doses of naloxegol from January 1, 2019, to June 30, 2020, for OIC at a tertiary care center. The primary endpoint of this study was to evaluate serious adverse events such as reduced analgesic effect, gastrointestinal perforation, seizure, acute myocardial infarction (AMI), or ventricular arrhythmias using Naranjo Scale in critically ill patients. The secondary goal was to assess the efficacy of naloxegol, measured by the time of the first bowel movement. Results The average duration of naloxegol use was three days, with the first bowel movement occurring at an average of 11.3 hours. Furthermore, 59.8% of individuals had their first bowel movement within 20 hours of receiving naloxegol. There was a low level of causality between naloxegol use and adverse events such as gastrointestinal perforation, seizures, AMI, cardiovascular mortality, stroke, and ventricular arrhythmia. Additionally, reduction in analgesia showed no strong relationship with naloxegol use indicated by the Naranjo Scale assessment. Conclusion Naloxegol showed promising safety and efficacy profiles in treating OIC amongst critically ill patients, though our findings require further validation through prospective studies. This research paves the way for further investigation into naloxegol's role in OIC management, emphasizing the necessity of personalized treatment strategies in critical care settings.
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Affiliation(s)
| | | | - Kristin Mara
- Department of Biostatistics, Mayo Clinic, Rochester, USA
| | - Scott Nei
- Department of Pharmacy, Mayo Clinic, Rochester, USA
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3
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Turan A, Fang J, Esa WAS, Hamadnalla H, Leung S, Pu X, Raza S, Chelnick D, Mounir Soliman L, Seif J, Ruetzler K, Sessler DI. Naloxegol and Postoperative Urinary Retention: A Randomized Trial. J Clin Med 2022; 11:jcm11020454. [PMID: 35054148 PMCID: PMC8780376 DOI: 10.3390/jcm11020454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Naloxegol antagonizes peripheral opioid-related side effects without preventing opioid-related analgesia. However, the effect of naloxegol on opioid-induced bladder dysfunction remains unknown. Hypothesis: patients given naloxegol have lower residual bladder urine volume than those given placebo. Methods: 136 patients scheduled for elective hip and knee surgery were randomized to oral naloxegol or placebo given the morning of surgery, and on the first two postoperative mornings. Residual urine volume was measured ultrasonographically within 30 min after voiding once in the morning and once in the afternoon for two postoperative days. Opioid-related Symptom Distress Scale (ORSDS), the need for indwelling urinary catheterization, and quality of recovery (QoR) score were secondary outcomes. Results: 67 were randomized to naloxegol and 64 to placebo. We did not identify a significant effect on urine residual volume, with an estimated ratio of geometric means of 0.9 (0.3, 2.6), p = 0.84. There were no significant differences in ORSDS or QoR. There were 19 (29%) patients assigned to naloxegol who needed indwelling urination catheterization versus 7 (11%) patients in the placebo group, p = 0.012. Conclusions: Our results do not support use of naloxegol for postoperative urinary retention after hip and knee surgery.
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Affiliation(s)
- Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA; (L.M.S.); (J.S.)
- Correspondence:
| | - Jonathan Fang
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
| | - Wael Ali Sakr Esa
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA; (L.M.S.); (J.S.)
| | - Hassan Hamadnalla
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
- Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health System, Detroit, MI 48202, USA
| | - Steve Leung
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
| | - Xuan Pu
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Syed Raza
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
| | - David Chelnick
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
| | - Loran Mounir Soliman
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA; (L.M.S.); (J.S.)
| | - John Seif
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA; (L.M.S.); (J.S.)
| | - Kurt Ruetzler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA; (L.M.S.); (J.S.)
| | - Daniel I. Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
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Mori H, Tack J, Suzuki H. Magnesium Oxide in Constipation. Nutrients 2021; 13:421. [PMID: 33525523 PMCID: PMC7911806 DOI: 10.3390/nu13020421] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
Magnesium oxide has been widely used as a laxative for many years in East Asia, yet its prescription has largely been based on empirical knowledge. In recent years, several new laxatives have been developed, which has led to a resurgence in interest and increased scientific evidence surrounding the use of magnesium oxide, which is convenient to administer, of low cost, and safe. Despite these advantages, emerging clinical evidence indicates that the use of magnesium oxide should take account of the most appropriate dose, the serum concentration, drug-drug interactions, and the potential for side effects, especially in the elderly and in patients with renal impairment. The aim of this review is to evaluate the evidence base for the clinical use of magnesium oxide for treating constipation and provide a pragmatic guide to its advantages and disadvantages.
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Affiliation(s)
- Hideki Mori
- Translational Research Center for Gastrointestinal Diseases (TARGID), University of Leuven, 3000 Leuven, Belgium; (H.M.); (J.T.)
| | - Jan Tack
- Translational Research Center for Gastrointestinal Diseases (TARGID), University of Leuven, 3000 Leuven, Belgium; (H.M.); (J.T.)
| | - Hidekazu Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara 259-1193, Japan
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Micheli L, Di Cesare Mannelli L, Lucarini E, Parisio C, Toti A, Fiorentino B, Rigamonti MA, Calosi L, Ghelardini C. Intranasal Low-Dose Naltrexone Against Opioid Side Effects: A Preclinical Study. Front Pharmacol 2020; 11:576624. [PMID: 33071790 PMCID: PMC7531600 DOI: 10.3389/fphar.2020.576624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/20/2020] [Indexed: 12/20/2022] Open
Abstract
Opioids are broad spectrum analgesics that are an integral part of the therapeutic armamentarium to combat pain in the clinical practice. Unfortunately, together with analgesia, a number of adverse effects can occur such as nausea, vomiting, constipation, gastrointestinal alterations and cognitive impairments. Naltrexone is a competitive antagonist of opioid receptors commonly used to treat opioid addiction; its oral use against agonists side effects is limited by the decrease of opioids-therapeutic efficacy and own adverse effects. The intranasal delivery of naltrexone could offer a quick and effective achievement of CNS based on extracellular mechanisms including perineural and perivascular transport. The aim of the study was to test the efficacy of intranasal low-dose naltrexone in reducing intraperitoneal morphine and oxycodone side effects in rodents. In mice, 1 μg naltrexone intranasally administered 30 min before opioids reduced cognitive impairments and motor alteration induced by 10 mg kg-1 morphine and 60 mg kg-1 oxycodone in the Passive avoidance and Rota rod tests, respectively. Moreover, naltrexone rebalanced opioid-induced reduction of the intestinal transit and latency of feces expulsion as well as food intake inhibition. Importantly, 1 μg naltrexone instillation did not block analgesia as demonstrated by the Hot plate test. In rats, intranasal naltrexone counteracted the opioid-induced pica phenomenon related to emesis and increased water and palatable food intake. The effects were comparable to that achieved by metoclopramide used as reference drug. Treatments did not influence body weight. Lastly, the safety of the intranasal delivery has been checked by hematoxylin-eosin staining that did not show histological alterations of the nasal cavity. In conclusion, intranasal low-dose naltrexone counteracted morphine and oxycodone induced gastrointestinal and CNS side effects without impairing opioid analgesia. It is a candidate to be a valid clinical strategy deserving deep analysis.
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Affiliation(s)
- Laura Micheli
- Department of Neuroscience, Psychology, Drug Research and Child Health - NEUROFARBA - Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Lorenzo Di Cesare Mannelli
- Department of Neuroscience, Psychology, Drug Research and Child Health - NEUROFARBA - Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Elena Lucarini
- Department of Neuroscience, Psychology, Drug Research and Child Health - NEUROFARBA - Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Carmen Parisio
- Department of Neuroscience, Psychology, Drug Research and Child Health - NEUROFARBA - Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Alessandra Toti
- Department of Neuroscience, Psychology, Drug Research and Child Health - NEUROFARBA - Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | | | | | - Laura Calosi
- Department of Experimental & Clinical Medicine, Section of Anatomy & Histology & Research Unit of Histology & Embryology, University of Florence, Florence, Italy
| | - Carla Ghelardini
- Department of Neuroscience, Psychology, Drug Research and Child Health - NEUROFARBA - Pharmacology and Toxicology Section, University of Florence, Florence, Italy
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6
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Lax NC, Chen R, Leep SR, Uhrich K, Yu L, Kolber B. PolyMorphine provides extended analgesic-like effects in mice with spared nerve injury. Mol Pain 2018; 13:1744806917743479. [PMID: 29108465 PMCID: PMC5692132 DOI: 10.1177/1744806917743479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Morphine is a well-characterized and effective analgesic commonly used to provide pain
relief to patients suffering from both acute and chronic pain conditions. Despite its
widespread use and effectiveness, one of the major drawbacks of morphine is its relatively
short half-life of approximately 4 h. This short half-life often necessitates multiple
administrations of the drug each day, which may contribute to both dependence and
tolerance to morphine. Here, we tested the analgesic properties of a new polymer form of
morphine known as PolyMorphine. This polymer has monomeric units of morphine incorporated
into a poly(anhydride-ester) backbone that has been shown to hydrolyze into free morphine
in vitro. Using an animal model of chronic pain, the spared nerve injury surgery, we
showed that PolyMorphine is able to block spared nerve injury-induced hypersensitivity in
mice for up to 24-h post-administration. Free morphine was shown to only block spared
nerve injury-induced hypersensitivity for up to 2-h post-injection. PolyMorphine was also
shown to act through the mu opioid receptor due to the ability of naloxone (a mu opioid
receptor antagonist) to block PolyMorphine-induced analgesia in spared nerve injury
animals pretreated with PolyMorphine. Additionally, we observed that PolyMorphine causes
similar locomotor and constipation side effects as free morphine. Finally, we investigated
if PolyMorphine had any effects in a non-evoked pain assay, conditioned place preference.
Pretreatment of spared nerve injury mice with PolyMorphine blocked the development of
conditioned place preference for 2-methyl-6-(phenylethynyl)pyridine (MPEP), a
short-lasting mGluR5 antagonist with analgesic-like properties. Free morphine does not
block the development of preference for MPEP, suggesting that PolyMorphine has longer
lasting analgesic effects compared to free morphine. Together, these data show that
PolyMorphine has the potential to provide analgesia for significantly longer than free
morphine while likely working through the same receptor.
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Affiliation(s)
- Neil C Lax
- Department of Biological Sciences andChronic Pain Research Consortium, Duquesne University, Pittsburgh, PA
| | - Renxun Chen
- Department of Chemistry and Chemical Biology
| | - Sarah R Leep
- Department of Biological Sciences andChronic Pain Research Consortium, Duquesne University, Pittsburgh, PA
| | | | - Lei Yu
- Department of Genetics and Center of Alcohol Studies, Rutgers University, Piscataway, NJ
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7
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Pannemans J, Corsetti M. Opioid receptors in the GI tract: targets for treatment of both diarrhea and constipation in functional bowel disorders? Curr Opin Pharmacol 2018; 43:53-58. [PMID: 30189347 DOI: 10.1016/j.coph.2018.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/11/2018] [Accepted: 08/13/2018] [Indexed: 02/08/2023]
Abstract
Opioids have been used for centuries, mostly as a sedative and to treat pain. Currently, they are used on a global scale for the treatment of acute and chronic pain in diseases as osteoarthritis, fibromyalgia, and low back pain. Binding of opioids on opioid receptors can cause a range of different effects such as changes in stress response, analgesia, motor activity and autonomic functions. This review provide a synthetic summary of the most recent literature on the use of drugs acting on mu-receptors to treat two prevalent functional bowel disorders, presenting with opposite bowel habit. Eluxadoline and naloxegol, methylnaltrexone and naldemedine are recently FDA and/or EMA approved drugs demonstrated to be effective and safe for treatment respectively of irritable bowel syndrome subtype diarrhea and opioid induced constipation.
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Affiliation(s)
- J Pannemans
- Catholic University of Leuven, KU Leuven, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
| | - M Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.
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8
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Grønlund D, Poulsen JL, Krogh K, Brock C, Liao D, Gregersen H, Drewes AM, Olesen AE. The impact of naloxegol on anal sphincter function - Using a human experimental model of opioid-induced bowel dysfunction. Eur J Pharm Sci 2018; 117:187-192. [PMID: 29432808 DOI: 10.1016/j.ejps.2018.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/23/2018] [Accepted: 02/06/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Opioid treatment interferes with anal sphincter function and its regulation during defecation. This may result in straining, incomplete evacuation, and contribute to opioid-induced bowel dysfunction (OIBD). Employing an experimental model of oxycodone-induced OIBD, we hypothesized that co-administration of the peripherally acting μ-opioid antagonist naloxegol would improve anal sphincter function in comparison to placebo. METHODS In a double-blind randomized crossover trial, 24 healthy males were assigned to a six-day treatment of oral oxycodone 15 mg twice daily in combination with either oral naloxegol 25 mg once daily or placebo. At baseline and at day 6, anal resting pressure and the recto-anal inhibitory reflex (RAIR) were evaluated using manometry and rectal balloon distension. Furthermore, the functional lumen imaging probe was used to measure distensibility of the anal canal. Gastrointestinal symptoms were assessed with the Patient Assessment of Constipation Symptom (PAC-SYM) questionnaire and the Bristol Stool Form Scale. RESULTS During oxycodone treatment, naloxegol improved RAIR-induced sphincter relaxation by 15% (-45.9 vs -38.8 mm Hg; P < 0.01). No differences in anal resting pressure and anal canal distensibility were found between treatments (all P > 0.5). Naloxegol improved PAC-SYM symptoms (mean score over days; 2.6 vs 4.5, P < 0.001) and improved stool consistency scores (mean score over days; 3.3 vs 2.9, P < 0.01). CONCLUSIONS In this experimental model of OIBD, naloxegol improved the RAIR and reduced gastrointestinal symptoms. Hence, in contrast to conventional laxatives, naloxegol may regulate opioid-induced anal sphincter dysfunction and facilitate the defecation process.
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Affiliation(s)
- Debbie Grønlund
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jakob L Poulsen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Klaus Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Christina Brock
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Drug Design and Pharmacology, University of Copenhagen, Denmark
| | - Donghua Liao
- GIOME Academia, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hans Gregersen
- GIOME, Department of Surgery, Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong
| | - Asbjørn M Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne E Olesen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Drug Design and Pharmacology, University of Copenhagen, Denmark.
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9
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Binder U, Skerra A. PASylation®: A versatile technology to extend drug delivery. Curr Opin Colloid Interface Sci 2017. [DOI: 10.1016/j.cocis.2017.06.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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10
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Miyazaki T, Choi IY, Rubas W, Anand NK, Ali C, Evans J, Gursahani H, Hennessy M, Kim G, McWeeney D, Pfeiffer J, Quach P, Gauvin D, Riley TA, Riggs JA, Gogas K, Zalevsky J, Doberstein SK. NKTR-181: A Novel Mu-Opioid Analgesic with Inherently Low Abuse Potential. J Pharmacol Exp Ther 2017; 363:104-113. [DOI: 10.1124/jpet.117.243030] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/02/2017] [Indexed: 12/27/2022] Open
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Yang H, Ma T. Luminally Acting Agents for Constipation Treatment: A Review Based on Literatures and Patents. Front Pharmacol 2017; 8:418. [PMID: 28713271 PMCID: PMC5491688 DOI: 10.3389/fphar.2017.00418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/13/2017] [Indexed: 12/11/2022] Open
Abstract
Constipation is one of the most frequently reported gastrointestinal (GI) disorders that negatively impacts quality of life and is associated with a significant economic burden to the patients and society. Traditional treatments including lifestyle modification and laxatives are often ineffective in the more severe forms of constipation and over the long term. New medications targeting at intestinal chloride channels and colonic serotonin receptors have been demonstrated effective in recent years. Emerging agents focusing on improving intestinal secretion and/or colonic motility have been shown effective in animal models and even in clinical trials. Recognization of the role of cystic fibrosis transmembrane regulator (CFTR) and calcium-activated chloride channels (CaCCs) in intestine fluid secretion and motility modulation makes CFTR and CaCCs promising molecule targets for anti-constipation therapy. Although there are multiple choices for constipation treatment, there is still a recognized need for new medications in anti-constipation therapy. The present review covers the discovery of luminally acting agents for constipation treatment described in both patents (2011–present) and scientific literatures.
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Affiliation(s)
- Hong Yang
- Liaoning Provincial Key Laboratory of Biotechnology and Drug Discovery, School of Life Sciences, Liaoning Normal UniversityDalian, China
| | - Tonghui Ma
- Institute of Traditional Chinese Medicine, Nanjing University of Chinese MedicineNanjing, China
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12
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Siemens W, Becker G. Methylnaltrexone for opioid-induced constipation: review and meta-analyses for objective plus subjective efficacy and safety outcomes. Ther Clin Risk Manag 2016; 12:401-12. [PMID: 27042082 PMCID: PMC4795449 DOI: 10.2147/tcrm.s80749] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction Opioid-induced constipation (OIC) is a frequent adverse event that impairs patients’ quality of life. This article evaluates the objective plus subjective efficacy and the safety of methylnaltrexone (MNTX) in OIC patients. Methods Randomized controlled trials from a recent systematic review were included. In addition, a PubMed search was conducted for January 2014 to December 21, 2015. We included randomized controlled trials with adult OIC patients, MNTX as study drug, and OIC as primary outcome. Results were categorized in three outcome types: objective outcome measures (eg, time to laxation), patient-reported outcomes (eg, straining), and global burden measures (eg, constipation distress). Dichotomous meta-analyses with risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using RevMan 5.3. Only comparisons between MNTX and placebo were made. Results We included seven studies with 1,860 patients. A meta-analysis revealed that patients under MNTX had considerably more rescue-free bowel movement within 4 hours after the first dose (RR 3.74, 95% CI 2.87 to 4.86; five studies, n=938; I2=0). Results of the review indicated that patients under MNTX had a higher stool frequency and needed less time to laxation compared with placebo. Moreover, patients receiving MNTX tended to have better values in patient-reported outcomes and global burden measures. Meta-analyses on safety revealed that patients under MNTX experienced more abdominal pain (RR 2.38, 95% CI 1.75 to 3.23; six studies, n=1,412; I2=60%) but showed a nonsignificant tendency in nausea (RR 1.27, 95% CI 0.90 to 1.78; six studies, n=1,412; I2=12%) and diarrhea (RR 1.45, 95% CI 0.94 to 2.24; five studies, n=1,258; I2=45%). The incidence of MNTX-related serious adverse events was 0.2% (4/1,860). Conclusion MNTX has been shown to be effective and safe. Future randomized controlled trials should consequently incorporate objective outcome measures, patient-reported outcomes, and global burden measures, and research the efficacy of MNTX in other populations, for example, patients under opioids after surgical procedures.
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Affiliation(s)
- Waldemar Siemens
- Clinic for Palliative Care, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerhild Becker
- Clinic for Palliative Care, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Rumman A, Gallinger ZR, Liu LWC. Opioid induced constipation in cancer patients: pathophysiology, diagnosis and treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/23809000.2016.1131595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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