Efficacy and Safety of Methylnaltrexone for the Treatment of Opioid-Induced Constipation: A Meta-analysis of Randomized Controlled Trials

Zhang, Yingying; Zhou, Rong; Gu, Wan‐Jie

doi:10.1007/s40122-021-00237-0

Cited by 6 publications

(2 citation statements)

References 32 publications

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“…The implementation of the bowel regimen protocol also resulted in a significant increase in the number of BMs for patients in the intervention group, in contrast to the comparison group. This finding is consistent with previous studies that have shown the effectiveness of bowel regimens in improving bowel function (Mozaffari et al, 2018; Zhang et al, 2021). The dynamic role of the case manager in the medical oncology unit helped the nursing and medical teams determine the BM status of oncology patients during the multidisciplinary rounds.…”

Section: Discussionsupporting

confidence: 93%

Bowel Management Protocol

Shanholtz,

Vergara,

Amba

et al. 2024

Professional Case Management

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Purpose of Study: The project aimed to determine the impact of a standardized bowel regimen protocol for patients receiving opioids on the rate of stool softener prescription, occurrence of bowel movements of oncology patients, and improving the length of stay (LOS). Primary Practice of Setting: Oncology unit in a community hospital. Methodology and Sample: A posttest design was utilized, and a prospective medical record review of patients was completed after 8 weeks of the pilot study. The study sample (N = 164) included oncology patients admitted to a community hospital in the Southeast. The χ2 test was used to determine the impact of implementing a bowel panel order on the rate of stool softener prescriptions, the occurrence of bowel movements, and the LOS. Results: Only 43% (n = 40) of the patients from the comparison group were ordered laxatives, and more patients from the intervention group (68%; n = 49) received the bowel regimen protocol, whereas 26% (n = 19) of the patients used a laxative or stool softener using providers' preference and demonstrated statistical significance (p = .001). In the intervention group, 93% of the patients (n = 67) reported having bowel movements compared with the comparison group, whereas only 32% (n = 32) demonstrated statistical significance (p = .001). The average LOS in the intervention group is less than 9 days compared with the comparison group, which was at 9 days (p = .001). Implications to Case Management Practice: Case managers play a critical role in coordinating care, improving transitions of care, and reducing LOS. Case managers can have a significant impact by monitoring and reminding nurses to report the gastrointestinal movements of oncology patients and then escalate opioid-induced constipation with the providers immediately. Case managers can facilitate the implementation of bowel regimen protocols, which may reduce hospitalizations and enhance patient outcomes, by taking this action.

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Section: Discussionsupporting

confidence: 93%

Bowel Management Protocol

Shanholtz,

Vergara,

Amba

et al. 2024

Professional Case Management

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“…Other aspects would have been interesting as well, e.g., the survival of patients affected by OIC treated or not-treated with PAMORAs like it has been reported for methylnaltrexone in advanced cancer patients [78]. Moreover, between the adverse events, we did not study the abdominal pain evoked by PAMORAs and its relationship with laxation, which has resulted very frequently in some groups of patients [79,80].…”

Section: Limitationsmentioning

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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Constipation in Cancer Patients — an Update of Clinical Evidence

Dzierżanowski

Mercadante

2022

Curr. Treat. Options in Oncol.

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Efficacy and Safety of Methylnaltrexone for the Treatment of Opioid-Induced Constipation: A Meta-analysis of Randomized Controlled Trials

Cited by 6 publications

References 32 publications

Bowel Management Protocol

Bowel Management Protocol

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

Constipation in Cancer Patients — an Update of Clinical Evidence

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