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5 Articles in this Series
Introduction
Audience Q&A: My Patients Don't See a Need for a Psychologist
Debate: Radiofrequency Ablation of the Hip (and Shoulder) Joint is Effective
Debate: SCS Is Better Than PNS for Back Pain
Inside the Poster: Methylnaltrexone for Opioid-Induced Constipation
The Deprescribing of Opioids: Toward Whole-Person Pain Care

Inside the Poster: Methylnaltrexone for Opioid-Induced Constipation

The primary objective of this post hoc analysis, The Effect of the Initial Dose of Methylnaltrexone in Advanced Illness Patients with Opioid-Induced Constipation,1 was to assess the efficacy and safety of a single methylnaltrexone bromide dose for opioid induced constipation (OIC) in advanced-illness patients who had an insufficient response to laxative therapy and who had varying levels of functional status at baseline.

The population studied - which was pooled from three multicenter, double-blind, randomized, placebo-controlled clinical trials - was representative of patients with chronic pain on opioids coming into the emergency room with OIC. These patients had been pre-treated with laxatives and enemas, yet these treatments had failed to relieve their constipation. Many of these patients were older, with multiple medical morbidities including advanced illnesses, such as active cancer (in fact, the most frequent primary diagnosis was cancer). Baseline functional levels were described using the World Health Organization (WHO) or Eastern Cooperative Oncology Group (ECOG) performance status scales. More than 50% had a significantly impaired functional status (ECOG 3 or 4).

Findings showed that 65% of patients who had a relatively good performance status (WHO or ECOG 2 or better) had a bowel movement response to methylnaltrexone bromide within four hours compared to 20% of patients receiving placebo. On further examination, most patients having a response did so within 2 hours, with 50% of overall responders having a laxation in 30 minutes or less. In patients with worse functional impairments (ECOG 3,4), 59% percent had a bowel movement response within 4 hoursof having being administered methylnaltrexone bromide compared to 13 % of patients receiving placebo.

There was no increase in pain scores in the treatment group versus pre-treatment. The most common adverse effects were abdominal pain, flatulence, nausea, vomiting, and dizziness. The abdominal pain was generally mild-moderate in intensity. Patients who received a second methylnaltrexone dose, had a lower incidence of adverse effects.

Overall, for this mostly laxative refractory population of adults with OIC, methylnaltrexone bromide rapidly promoted laxation in approximately two-thirds of the patients regardless of their functional status.

 

Peacock FW, Slatkin N, Israel R, Stamber N. The Effect of the Initial Dose of Methylnaltrexone in Advanced Illness Patients with Opioid-Induced Constipation. Presented at the: AAPM Annual Meeting, National Harbor, MD, February 26-March 1, March 2020. Disclosure: Dr. Peacock has received research grants from Salix, which manufacturers OIC product(s).

Next summary: The Deprescribing of Opioids: Toward Whole-Person Pain Care
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