Efficacy and safety of alvimopan use in benign urinary tract reconstruction

Hensley, Patrick J.; Higgins, Margaret; Rasper, Alison M.; Ziada, Ali; Coleman, Clyde; Ruf, Kathryn M.; Gupta, Shubham

doi:10.1007/s11255-020-02621-9

Cited by 4 publications

(2 citation statements)

References 9 publications

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“…18 For example, alvimopan, a mu-opioid receptor antagonist, was approved for RC in 2013 to minimize the risk of postoperative ileus. 19 Another key to lowering LOS and health care costs is to reduce postoperative complications following RC. 20 It is well established that volume outcome relationships have been shown with complex oncologic operations.…”

Section: Discussionmentioning

confidence: 99%

Association of Surgical Approach and Urinary Diversion in Radical Cystectomy for Bladder Cancer With Costs and Readmission: Results From a Large Private Health Insurance Cohort

Rodriguez-Homs¹,

Pessôa²,

Konety

et al. 2022

Urology Practice

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Introduction:We sought to assess the comparative hospital outcomes and costs among a population-based cohort of bladder cancer patients by surgical approach and diversion.Methods: From a privately insured national database, we identified all bladder cancer patients who underwent open or robotic radical cystectomy and ileal conduit or neobladder from 2010 to 2015. The primary outcomes were length of stay, readmissions, and total health care costs at 90 days from surgery. We used multivariable logistic regression and generalized estimating equations to assess for 90-day readmission and health care costs, respectively. Results:Most patients underwent open radical cystectomy with ileal conduit (56.7%; n ¼ 1,680) followed by open radical cystectomy with neobladder (22.7%; n ¼ 672), robotic radical cystectomy with ileal conduit (17.4%; n ¼ 516), and robotic radical cystectomy with neobladder (3.1%; n ¼ 93). On multivariable analysis, patients had higher odds of 90-day readmissions for open radical cystectomy and neobladder (OR: 1.36; P ¼ .002) and robotic radical cystectomy with neobladder (OR 1.60; P ¼ .03) relative to open radical cystectomy with ileal conduit. After adjusting for patient covariates, we also found lower adjusted total 90-day health care costs for open radical cystectomy with ileal conduit

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Section: Discussionmentioning

confidence: 99%

Association of Surgical Approach and Urinary Diversion in Radical Cystectomy for Bladder Cancer With Costs and Readmission: Results From a Large Private Health Insurance Cohort

Rodriguez-Homs¹,

Pessôa²,

Konety

et al. 2022

Urology Practice

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“…This drug could possibly serve as a part of Enhanced Recovery After Surgery protocols (ERAS) [62]. Further studies have to be undertaken in order to establish a definitive conclusion regarding cost-effectiveness, safety and effect on pain scores, as the existing results are inconclusive [63,64].…”

Section: Figure 3: Speed Of Action (Hours After Oral Administration)mentioning

confidence: 99%

Efficacy and Safety of Peripherally Acting μ-Opioid Receptor Antagonist (PAMORAs) for the Management of Patients With Opioid-Induced Constipation: A Systematic Review

Rekatsina

Paladini

Drewes

et al. 2021

Cureus

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In treating chronic and acute pain, opioids are widely used. Although they do provide analgesia, their usage does come with adverse events (AEs). One of the most burdensome is opioid-induced bowel dysfunction, and more specifically opioid-induced constipation (OIC). The pathogenesis of these AEs is well known as the consequence of the action of opioids on m-receptors in the enteric nervous system. In recent years, medicines counteracting this specific action at the receptors have been registered for clinical use: the peripherally acting μ-opioid receptor antagonists (PAMORAs). The knowledge of their comparative efficacy and tolerability is very important for physicians and patients in opioid therapy. This systematic review of the existing literature on PAMORAs aimed to study the relative clinical advantages and disadvantages.The most important data banks, including "PubMed," "Embase," "CT.gov," "ICTRP" and "CINAHL" were used to find the published material on PAMORAs. The selected publications were examined to systematically analyze the efficacy and safety of the four existing PAMORAs.All of the medications are superior to placebo in reducing OIC. There are few published data on alvimopan used to treat OIC, and it is only indicated for the treatment of post-abdominal surgery ileus. Methylnaltrexone is studied mainly in its subcutaneous (SC) formulation. When used in its oral formulation, it seems more rapid than naloxegol and placebo in the reduction of OIC. Naldemedine is able to produce more spontaneous bowel movements (SBMs) when compared to alvimopan and naloxegol.Tolerability was found to be similar for all of them. In particular, they affect the gastrointestinal tract (GI), with flatulence and diarrhea, especially at high dosages. For some of them, nasopharyngitis and abdominal pain were observed as treatment adverse effects (TEAs). Several cardiovascular TEAs were reported after methylnaltrexone use, but it is not clear whether they were consequences of the drug or related to the general conditions of the patients.Considering the existing data, naloxegol and naldemedine seem to be the best choices, with a higher number of spontaneous bowel movements following naldemedine administration.

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