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Leyendecker P, Roustan FR, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Diagnosis. Prog Urol 2023; 33:782-790. [PMID: 37918979 DOI: 10.1016/j.purol.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The choice of imaging modality is guided by the clinical presentation and the context (acute or not). Although ultrasound is safe (no radiation) and easily available, non-contrast-enhanced CT has become the gold standard in the diagnostic strategy for patients with acute flank pain because of its sensitivity (93.1%) and specificity (96.6%). It also allows determining the stone size, volume and density, visualizing their internal structure, and assessing their distance from the skin and the adjacent anatomy. All these parameters can influence the stone management and the choice of intervention modality. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendations method (CPR) and the ADAPTE method, depending on whether the issue was considered in the EAU recommendations (https://uroweb.org/guidelines/urolithiasis [EAU Guidelines on urolithiasis. 2022]) and their adaptability to the French context.
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Affiliation(s)
- P Leyendecker
- Service de radiologie B, nouvel hôpital Civil, hôpitaux universitaires de Strasbourg, groupe d'imagerie médicale MIM, AFR-SIGU, Strasbourg, France
| | | | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP-centre université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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2
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Minault Q, Barthélémy P, Leyendecker P, Mielcarek M, Roy C. 740P Response assessment in advanced renal cell carcinoma (mRCC) patients (pts) treated by Nivolumab (N) + Ipilimumab (I): CT volumetric measurement versus RECIST 1.1 response criteria. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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3
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Roy C, de Marini P, Labani A, Leyendecker P, Ohana M. Shear-wave elastography of the testicle: potential role of the stiffness value in various common testicular diseases. Clin Radiol 2020; 75:560.e9-560.e17. [PMID: 32248949 DOI: 10.1016/j.crad.2020.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 02/25/2020] [Indexed: 01/27/2023]
Abstract
AIM To assess the value and efficacy of real-time shear-wave elastography (SWE) of normal testicular parenchyma and various common testicular diseases in clinical practice. MATERIALS AND METHODS SWE was undertaken in 338 patients (mean age: 43.2±17.2 years, range 17-78 years) comprising normal testicles (n = 358), testicular microlithiasis (n = 40), and various testicular diseases (n = 208) and the stiffness was recorded. The final diagnosis was correlated with the clinical context, long-term follow-up, or histopathology. Statistical evaluation was performed to provide a stiffness threshold for pathological diagnosis. RESULTS The mean size of testicular lesions was 2.6±1.5 cm (range: 10-42 mm). The mean Young's modulus value for normal testis was recorded at 4.55±2.54 kPa. Whatever the stage of microlithiasis, a higher statistically significant stiffness value was recorded. For acute orchitis, the mean stiffness value was slightly higher, but not statistically significantly. The testicular tumoural processes presented a median stiffness value of 21.02 kPa with a cut-off of 16.1 kPa. Fibrosis presented the highest median stiffness value of 30.03 kPa with a cut-off of 26.3 kPa. By analysing the distribution of the different pathological groups, the difference was statistically significant between fibrosis and tumoural processes (p = 0.001). CONCLUSION SWE is a feasible technique in the exploration of the testicular parenchyma. SWE values can be used to differentiate testicular fibrosis from a tumoural process with confidence.
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Affiliation(s)
- C Roy
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l' hôpital BP 426, Strasbourg, 67091, Cedex, France.
| | - P de Marini
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l' hôpital BP 426, Strasbourg, 67091, Cedex, France
| | - A Labani
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l' hôpital BP 426, Strasbourg, 67091, Cedex, France
| | - P Leyendecker
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l' hôpital BP 426, Strasbourg, 67091, Cedex, France
| | - M Ohana
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l' hôpital BP 426, Strasbourg, 67091, Cedex, France
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Ludes C, Labani A, Severac F, Jeung MY, Leyendecker P, Roy C, Ohana M. Ultra-low-dose unenhanced chest CT: Prospective comparison of high kV/low mA versus low kV/high mA protocols. Diagn Interv Imaging 2018; 100:85-93. [PMID: 30559037 DOI: 10.1016/j.diii.2018.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To qualitatively and quantitatively compare unenhanced ultra-low-dose chest computed tomography (ULD-CT) acquired at 80kVp and 135kVp. MATERIALS AND METHODS Fifty-one patients referred for unenhanced chest CT were prospectively included. There were 29 men and 22 women, with a mean age of 64.7±11.6 (SD) years (range: 35-91 years) and a mean body mass index of 26.2±6.3 (SD) (range: 17-54.9). All patients underwent two different ULD-CT protocols (80kVp-40mA and 135kVp-10mA). Image quality of both ULD-CT examinations using a 5-level scale as well as assessability of 6 predetermined lung parenchyma lesions were blindly evaluated by three radiologists and compared using a logistic regression model. Image noise of the two protocols was compared with Wilcoxon signed-rank test. RESULTS The mean dose-length product at 80kVp and at 135kVp were 14.7±1.8 (SD) mGy.cm and 15.6±1.9 (SD) mGy.cm, respectively (P<0.001). Image noise was significantly lower at 135kVp (58.9±12.4) than at 80kVp (74.7±14.5) (P<0.001). For all readers and for all examinations, the 135kVp protocol yielded better image quality than 80kVp protocol, with a mean qualitative score of 4.5±0.7 versus 3.9±0.8 (P<0.001). The 135kVp protocol was significantly more often of diagnostic quality than the 80kvp protocol (92.3% versus 77.8%, respectively) (P<0.001) and was less prone to image quality deterioration in obese patients. Parenchymal lesions were never better depicted on the 80kVp protocol than with the 135kVp protocol. CONCLUSION Unenhanced chest ULD-CT should be acquired at a high kilovoltage and low current, such as 135kVp-10mA, over a low kilovoltage and high current protocol.
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Affiliation(s)
- C Ludes
- Department of Radiology B, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - A Labani
- Department of Radiology B, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - F Severac
- Department of Public Health, Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; iCube Laboratory, Université de Strasbourg, CNRS, UMR 7357, 67400 Illkirch, France
| | - M Y Jeung
- Department of Radiology B, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - P Leyendecker
- Department of Radiology B, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - C Roy
- Department of Radiology B, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - M Ohana
- Department of Radiology B, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; iCube Laboratory, Université de Strasbourg, CNRS, UMR 7357, 67400 Illkirch, France.
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Velay A, Kack-Kack W, Abravanel F, Lhomme S, Leyendecker P, Kremer L, Chamouard P, Izopet J, Fafi-Kremer S, Barth H. Parsonage-Turner syndrome due to autochthonous acute genotype 3f hepatitis E virus infection in a nonimmunocompromised 55-year-old patient. J Neurovirol 2017; 23:615-620. [PMID: 28439773 DOI: 10.1007/s13365-017-0525-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/06/2017] [Accepted: 03/13/2017] [Indexed: 01/05/2023]
Abstract
Hepatitis E virus (HEV) infection is an emerging autochthonous disease in industrialized countries. Extra-hepatic manifestations, in particular neurologic manifestations, have been reported in HEV infection. Only a few cases of hepatitis E-associated Parsonage-Turner syndrome have been reported, and HEV genotypes were rarely determined. Here, we report the case of a Parsonage-Turner syndrome associated with an acute autochthonous HEV infection in a 55-year-old immunocompetent patient. HEV genomic RNA was detected in serum and cerebrospinal fluid samples (CSF), and molecular phylogenetic analysis of HEV was performed. The interest of this case lies in its detailed description notably the molecular analysis of HEV RNA isolated from serum and CSF. HEV infection should be considered in diagnostic investigations of neurologic manifestations associated with liver function perturbations.
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Affiliation(s)
- A Velay
- Virology Laboratory, University Hospital of Strasbourg, F-67000, Strasbourg, France. .,INSERM, IRM UMR-S 1109, F-67000, Strasbourg, France.
| | - W Kack-Kack
- Virology Laboratory, University Hospital of Strasbourg, F-67000, Strasbourg, France.,INSERM, IRM UMR-S 1109, F-67000, Strasbourg, France
| | - F Abravanel
- INSERM, U1043, Centre de Physiopathologie de Toulouse Purpan, F-31300, Toulouse, France.,CHU Toulouse Hôpital Purpan, Laboratoire de virologie, Institut fédératif de biologie de Purpan, F-31300, Toulouse, France
| | - S Lhomme
- INSERM, U1043, Centre de Physiopathologie de Toulouse Purpan, F-31300, Toulouse, France.,CHU Toulouse Hôpital Purpan, Laboratoire de virologie, Institut fédératif de biologie de Purpan, F-31300, Toulouse, France
| | - P Leyendecker
- Department of Neuroradiology, University Hospital of Strasbourg, F-67098, Strasbourg, France
| | - L Kremer
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques, UMR_S INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - P Chamouard
- Department of Gastroenterology and Hepatology, University Hospital of Strasbourg, F-67098, Strasbourg, France
| | - J Izopet
- INSERM, U1043, Centre de Physiopathologie de Toulouse Purpan, F-31300, Toulouse, France.,CHU Toulouse Hôpital Purpan, Laboratoire de virologie, Institut fédératif de biologie de Purpan, F-31300, Toulouse, France
| | - S Fafi-Kremer
- Virology Laboratory, University Hospital of Strasbourg, F-67000, Strasbourg, France.,INSERM, IRM UMR-S 1109, F-67000, Strasbourg, France
| | - H Barth
- Virology Laboratory, University Hospital of Strasbourg, F-67000, Strasbourg, France.,INSERM, IRM UMR-S 1109, F-67000, Strasbourg, France
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Rentz AM, van Hanswijck de Jonge P, Leyendecker P, Hopp M. Observational, nonintervention, multicenter study for validation of the Bowel Function Index for constipation in European countries. Curr Med Res Opin 2011; 27:35-44. [PMID: 21083515 DOI: 10.1185/03007995.2010.535270] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Constipation is a common adverse event of treatment with opioids for chronic non-malignant pain and may result in a considerable reduction in health-related quality of life. The aim of this study was to assess the psychometric properties of the Bowel Function Index (BFI) in european patients suffering from constipation secondary to opioid analgesic treatment for chronic, non-malignant pain. METHODS This was a multinational study conducted at 15 clinical sites in the Czech Republic, Germany, Italy, and the United Kingdom. Patients suffering from constipation secondary to opioid analgesic treatment for chronic, non-malignant pain were recruited to complete a series of questionnaires including a socio-demographic form, the BFI, the Patient Assessment of Constipation - Symptoms (PAC-SYM), a global frequency item, and a clinical form. RESULTS A total of 131 patients were included in this study. Inter-item correlations of the BFI were statistically significant in the moderate to large range and the analysis indicated a strong degree of internal consistency (Cronbach's alpha = 0.86). All correlations between the BFI and the global item were statistically significant in the moderate to high range (r = 0.59 to 0.69; p < 0.0001). Correlations between the BFI and the PAC-SYM were moderate and statistically significant (p < 0.01 to 0.0001). CONCLUSIONS Although this study was limited by the relatively small sample size, it is a part of an extensive validation program. This study suggests that the BFI is a reliable and valid measure of constipation-related symptomatology in chronic pain patients. This measure may be a valuable indicator of patients' experience of symptoms of opioid treatment of chronic pain in future trials.
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Affiliation(s)
- A M Rentz
- Center for Health Outcomes Research, United BioSource Corporation, Bethesda, MD, USA
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Sandner-Kiesling A, Leyendecker P, Hopp M, Tarau L, Lejcko J, Meissner W, Sevcik P, Hakl M, Hrib R, Uhl R, Dürr H, Reimer K. Long-term efficacy and safety of combined prolonged-release oxycodone and naloxone in the management of non-cancer chronic pain. Int J Clin Pract 2010; 64:763-74. [PMID: 20370845 PMCID: PMC2948431 DOI: 10.1111/j.1742-1241.2010.02360.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess safety and efficacy of fixed combination oxycodone prolonged release (PR)/naloxone PR in terms of both analgesia and improving opioid-induced bowel dysfunction (OIBD) and associated symptoms, such as opioid-induced constipation (OIC), in adults with chronic non-cancer pain. STUDY DESIGN These were open-label extension studies in which patients who had previously completed a 12-week, double-blind study received oxycodone PR/naloxone PR for up to 52 weeks. The analgesia study assessed pain using the modified Brief Pain Inventory-Short Form (BPI-SF). The bowel function study assessed improvements in constipation using the Bowel Function Index (BFI). RESULTS At open-label baseline in the analgesia study (n = 379), mean score [+/- standard deviation (SD)] for the BPI-SF item 'average pain over the last 24 h' was 3.9 +/- 1.52, and this remained low at 6 months (3.7 +/- 1.59) and 12 months (3.8 +/- 1.72). Mean scores for BPI-SF item 'sleep interference', and the BPI-SF 'pain' and 'interference with activities' subscales also remained low throughout the 52-week study. In the bowel function study (n = 258), mean BFI score (+/- SD) decreased from 35.6 +/- 27.74 at the start of the extension study to 20.6 +/- 24.01 after 12 months of treatment with oxycodone PR/naloxone PR. Pain scores also remained low and stable during this study. Adverse events in both extension phases were consistent with those associated with opioid therapy; no additional safety concerns were observed. CONCLUSION Results from these two open-label extension studies demonstrate the long-term efficacy and tolerability of fixed combination oxycodone PR/naloxone PR in the treatment of chronic pain. Patients experienced clinically relevant improvements in OIBD while receiving effective analgesic therapy.
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Affiliation(s)
- A Sandner-Kiesling
- Department of Anaesthesiology and Intensive Care Medicine, Medical University, Graz, Austria
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Löwenstein O, Leyendecker P, Hopp M, Schutter U, Rogers PD, Uhl R, Bond S, Kremers W, Nichols T, Krain B, Reimer K. Combined prolonged-release oxycodone and naloxone improves bowel function in patients receiving opioids for moderate-to-severe non-malignant chronic pain: a randomised controlled trial. Expert Opin Pharmacother 2009; 10:531-43. [PMID: 19243306 DOI: 10.1517/14656560902796798] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND This randomised, double-blind, double-dummy, parallel-group multicentre study assessed the impact of a total daily dose of 60-80 mg oral oxycodone prolonged-release (PR)/naloxone PR (OXN PR) as fixed-ratio combination for patients with opioid-induced constipation (OIC) having moderate-to-severe, non-malignant pain. METHODS During pre-randomisation patients receiving opioids for moderate-to-severe non-malignant pain were converted to oxycodone PR (OXY PR) and titrated to an effective analgesic dose. During randomisation 265 patients on a stable OXY PR dose (60-80 mg/day) and with OIC were included in the full analysis population to receive OXN PR or OXY PR alone. Primary outcome was improvement in symptoms of constipation as measured by the Bowel Function Index (BFI). Secondary/exploratory outcomes examined analgesic efficacy and other bowel function parameters. RESULTS After 4 weeks of treatment, patients receiving OXN PR showed a significant improvement in bowel function compared with those in the OXY PR group (-14.9; 95% CI: -17.9, -11.9; p<0.0001) as measured by BFI which was seen after only 1 week of treatment continuing to the end of the study. After 4 weeks of treatment, patients receiving OXN PR had a median number of 3.0 complete spontaneous bowel movements (CSBM) per week compared with only 1.0 for OXY PR alone. Laxative intake was lower in the OXN PR than the OXY PR group. Furthermore, improvements in bowel function were achieved without loss of analgesic efficacy; pain intensity scores were comparable between the groups and consistent for duration of the study. Most frequently reported adverse events were consistent with those reported for opioid analgesics; no new or unexpected adverse reactions attributable to OXN PR used in higher doses were observed. CONCLUSION This study shows that the fixed-ratio combination of OXN PR is superior to OXY PR alone in terms of bowel function, while providing effective equivalent analgesia.
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Affiliation(s)
- O Löwenstein
- Mundipharma Research GmbH & Co KG, Limburg (Lahn), Germany
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Abstract
OBJECTIVE The Bowel Function Index (BFI) is a clinician-administered, patient-reported, 3-item questionnaire to evaluate opioid-induced constipation in cancer and non-cancer chronic pain patients. The objective of the present analysis was to evaluate the psychometric characteristics of the BFI using data from clinical studies of oral prolonged release (PR) oxycodone/naloxone. METHODS OXN2401 was a multicenter, controlled, randomized, double-blind, parallel-group study including oral PR oxycodone combined with oral PR naloxone as well as oral PR oxycodone combined with corresponding naloxone placebo. OXN3401 and OXN3001 were 12-week multicenter, controlled, randomized, double-blind, parallel-group studies of a fixed combination of oral PR oxycodone/naloxone versus PR oxycodone. In addition, a placebo group was included in study OXN3401. BFI psychometric characteristics (reliability, reproducibility, convergent/known groups validity, and responsiveness) were evaluated. RESULTS Demographic data (n=985) were comparable and analyses indicated a high degree of internal consistency (Cronbach's alpha >0.7). Change of less than 5 points in BFI was indicative of high reproducibility. Correlations between BFI item and total scores to stool frequency were statistically significant and in the low-to-moderate range (OXN2401 -0.23 to -0.29, p < 0.001; OXN3401 range -0.26 to -0.40, p < 0.001; OXN3001 -0.14 to -0.15, p < 0.05). Data indicate that a BFI score change of ≥12 points represents a clinically meaningful change in constipation. LIMITATIONS This publication for validation of BFI only includes data from three clinical trials. However, another publication of an additional specifically designed cross-sectional validation study is in preparation. CONCLUSION The BFI is a valid and reliable instrument for the assessment of opioid-induced constipation in chronic pain patients. Psychometric analyses from clinical trials support the BFI's psychometric properties.
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Affiliation(s)
- A M Rentz
- Center for Health Outcomes Research, United Biosource Corporation, Bethesda, MD, USA
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Simpson K, Leyendecker P, Hopp M, Müller-Lissner S, Löwenstein O, De Andrés J, Troy Ferrarons J, Bosse B, Krain B, Nichols T, Kremers W, Reimer K. Fixed-ratio combination oxycodone/naloxone compared with oxycodone alone for the relief of opioid-induced constipation in moderate-to-severe noncancer pain. Curr Med Res Opin 2008; 24:3503-12. [PMID: 19032132 DOI: 10.1185/03007990802584454] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Opioid therapy is frequently associated with treatment-limiting constipation. Naloxone is an opioid antagonist with low oral systemic bioavailability. This Phase III clinical trial assessed the safety and efficacy of an oral fixed-ratio combination of oxycodone prolonged-release (PR) and naloxone PR compared with oxycodone PR in relieving opioid-induced constipation. STUDY DESIGN This double-blind, multicenter trial was conducted in specialist and primary care centers in four European countries in an out-patients setting. The study included 322 adult patients with moderate-to-severe, noncancer pain requiring opioid therapy in a range of >or=20 mg/day and <or=50 mg/day oxycodone. Following a run-in phase patients were randomized to receive oxycodone PR/naloxone PR or oxycodone PR for 12 weeks. The primary outcome was improvement in constipation as measured using the Bowel Function Index (BFI). Secondary/exploratory assessments focused on pain intensity and additional bowel parameters. TRIAL REGISTRATION NCT00412152. RESULTS A significant improvement in BFI scores occurred with oxycodone PR/naloxone PR compared with oxycodone PR after 4 weeks of double-blind treatment (-26.9 vs. -9.4, respectively; p < 0.0001), observed after only 1 week of treatment and continued until study end. A significant increase in the number of complete spontaneous bowel movements and decrease in laxative use were also reported. This improvement in bowel function was achieved without compromising the analgesic efficacy of the oxycodone component; pain intensity remained constant throughout the study. The incidence of adverse events was comparable in both groups and consistent with those expected of opioid analgesics. As the study was limited to a dose range of up to 50 mg oxycodone equivalent per day, further research on higher doses would be recommended. CONCLUSION The fixed-ratio combination of oxycodone PR/naloxone PR is superior to oxycodone PR alone, offering patients effective analgesia while significantly improving opioid-induced constipation.
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Abstract
BACKGROUND AND OBJECTIVES Opioid-induced constipation can have a major negative impact on patients' quality of life. This randomised clinical trial evaluated patient assessment of the efficacy and tolerability of oral prolonged-release (PR) oxycodone when co-administered with oral naloxone PR. METHODS Two hundred and two patients with chronic cancer- or non-cancer-related pain undergoing stable oxycodone PR therapy (40, 60 or 80 mg/day) were randomised to one of four intervention groups: 10, 20 or 40 mg/day naloxone PR or placebo. Following a 4-week maintenance phase, patients were followed-up for 2 weeks in which time they received oxycodone PR only. At the end of the maintenance phase, patients and investigators were asked to assess treatment efficacy and tolerability, as well as preference for the titration or maintenance phase. RESULTS Patient and investigator global assessment of efficacy and tolerability improved with increasing naloxone dose. Efficacy was ranked as 'good' or 'very good' by 50.0%, 67.4% and 72.5% of patients in the 10, 20 and 40 mg naloxone PR dose groups, respectively, compared with 43.5% of patients in the placebo group. Patient assessment of tolerability was similar between treatment groups and placebo, being ranked as 'good' or 'very good' by 83.3%, 79.1% and 82.5% of patients in the 10, 20 and 40 mg/day naloxone PR dose groups, respectively, compared with 71.7% of patients in the placebo group. The maintenance treatment phase was preferred by patients in the naloxone groups. A 2 : 1 dose ratio of oxycodone to naloxone was also assessed. Efficacy was ranked as 'good' or 'very good' by 70.4% of patients treated with the 2 : 1 dose ratio compared with 43.5% of patients receiving placebo. Tolerability of the 2 : 1 dose ratio was ranked as being 'good' or 'very good' by 81.5% of patients compared with 71.1% for the placebo group and patients preferred the maintenance phase. CONCLUSIONS The co-administration of oral naloxone PR with oxycodone PR improves patient assessment of analgesic opioid therapy for severe chronic pain, in terms of both efficacy and tolerability.
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Affiliation(s)
- J Nadstawek
- Clinic of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany
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Leyendecker P. [Disinfection of beds]. Dtsch Zentralbl Krankenpfl 1966; 10:306-8. [PMID: 5177653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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