Use of naldemedine is associated with reduced incidence of hyperactive delirium in cancer patients with opioid‐induced constipation: A nationwide retrospective cohort study in Japan

Abstract

Background Medical benefits of peripherally acting mu‐opioid receptor antagonists other than improving opioid‐induced constipation remain unclear. Our aim was to evaluate the association between the use of naldemedine and incidence of hyperactive delirium in cancer patients receiving chemotherapy and opioid therapy. Methods We conducted a propensity score‐matched analysis using a nationwide inpatient database in Japan. Cancer patients receiving both inpatient chemotherapy and opioid therapy from June 1, 2017, to March 31, 2018, were included. Patients receiving naldemedine were matched to control patients by propensity score. Our primary outcome was the incidence of hyperactive delirium during hospitalization, and secondary outcomes were the length of hospital stay, hospital costs, in‐hospital mortality, and incidence of ileus. Results Of 34,031 patients receiving inpatient chemotherapy and opioid therapy, 1905 (5.6%) were included in the naldemedine group. After one‐to‐four propensity score matching, 1904 patients were included in the naldemedine group and 7616 in the control group. Naldemedine users had significantly reduced incidence of hyperactive delirium compared with the control patients (19.4% vs 23.3%; risk difference, −3.9 [95% confidence interval, −5.9 to −1.9]; risk ratio, 0.83 [0.75–0.92]; p<0.001; subdistribution hazard ratio, 0.85 [0.75–0.97]; p = 0.015). The median length of hospital stay was significantly shorter in the naldemedine group compared with the control group (12 days [interquartile range, 6–23] vs 14 days [6–26]; p = 0.001). The median hospital costs were also significantly lower in the naldemedine group compared with the control group (US $6179 [3351–10,026] vs US $6576 [3436–11,107]; p < 0.001). No significant differences were found for in‐hospital mortality or incidence of ileus between the groups. Conclusions Our findings suggest that the use of naldemedine may have benefits in preventing hyperactive delirium, shortening hospital stay, and decreasing hospital costs in cancer patients receiving chemotherapy and opioid therapy.

Naldemedine and Magnesium Oxide as First-Line Medications for Opioid-Induced Constipation: A Comparative Database Study in Japanese Patients With Cancer Pain

“…In a retrospective study, it has been reported that naldemedine can reduce hospital costs and hospital stays by reducing the incidence of hyperactive delirium [ 28 ]. In the present study, the total medical costs six months after opioid initiation were low in the naldemedine arm compared to the magnesium oxide arm in the non-early prescription group, but not in the early prescription group.…”

Comparison of the Effects of Combined Femoral and Sciatic Nerves Block versus General Anesthesia on Hemodynamic Stability and Postoperative Complication in Patients with Diabetic Foot: A Prospective, Double-Blind and Randomized Controlled Trial

“…[18][19][20] In addition, there are many adverse reactions caused by general anesthetics, especially nausea and vomiting, constipation, hypotension, respiratory depression and hyperalgesia caused by opioids. [21][22][23][24] There are few data currently available from published studies that compared peripheral nerve blocks with general anesthesia for patients who underwent DF surgery. To compare the effects of the above two different anesthesia methods on the perioperative physiological function of patients, this study intends to prospectively analyze the impact of general anesthesia versus peripheral nerve block anesthesia on perioperative hemodynamic changes and the prognosis of diabetic patients to evaluate the beneficial and detrimental effects of the two different anesthesia methods on patients.…”

“… 18–20 In addition, there are many adverse reactions caused by general anesthetics, especially nausea and vomiting, constipation, hypotension, respiratory depression and hyperalgesia caused by opioids. 21–24 …”