Use of Peripheral μ-Opioid Receptor Antagonists for Treating Opioid-Induced Constipation among US Medicare Beneficiaries from 2014 to 2018

Premnath, Naveen; Sumarsono, Andrew; Sedhom, Ramy; Johnson, David H.; Subbiah, Ishwaria Mohan; Dy, Sydney M.; Gupta, Arjun

doi:10.1089/jpm.2021.0021

Cited by 5 publications

(6 citation statements)

References 9 publications

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“…Advances in anticancer drugs have been accompanied by market entry of costly supportive care medications, including some antiemetics. 3,4 Their unwarranted use can result in wasteful spending. 4 Reflecting this, the 2012-2013 ASCO Choosing Wisely recommendations emphasized the appropriate use of antiemetics.…”

Section: Quantity Limitsmentioning

confidence: 99%

Payer-Imposed Quantity Limits for Antiemetics: Everybody Hurts

Haque

Sedhom

Chino

et al. 2022

JCO Oncology Practice

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Section: Quantity Limitsmentioning

confidence: 99%

Payer-Imposed Quantity Limits for Antiemetics: Everybody Hurts

Haque

Sedhom

Chino

et al. 2022

JCO Oncology Practice

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“…16 At present, four PAMORAs approved by the United States' Food and Drug Administration (FDA) are available for treating OIC orally: methylnaltrexone, alvimopan, naldemedine, and naloxegol. 17,18 Chemically derived from naloxone by the addition of PEGylated (polyethylene glycol modified) chain, 19 naloxegol (Moventig ® ) was the first oral PAMORA to receive approval from both the FDA (September 2014) and the European Medicines Agency (EMA) (December 2014) for treating OIC. 20,21 Naloxegol is indicated for the treatment of OIC in adult patients who have had an inadequate response to laxative(s), that is, concurrent OIC symptoms of at least moderate severity while taking at least one laxative class for a minimum of four days.…”

Section: Introductionmentioning

confidence: 99%

An observational post‐authorization safety study (PASS) of naloxegol drug utilization in four European countries

Kvarstein,

Kindlundh‐Högberg,

Ould Setti

et al. 2023

Pharmacoepidemiology and Drug

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PurposeNaloxegol has been shown to be an efficient alternative to treat opioid‐induced constipation (OIC). This study aimed at describing the characteristics of naloxegol users and assessing patterns of naloxegol use and associated factors.MethodsThis drug utilization cohort study used observational registry data on patients newly prescribed naloxegol in four European countries. Patient characteristics and patterns of naloxegol use and associated factors were described.ResultsA total of 17 254 naloxegol users were identified across the countries. Their median age was 56–71 years, and each country had a majority of women (ranging 57.5%–62.9%). Multiple comorbidities, including cancer, were common. Natural opium alkaloids and osmotically acting laxatives (excluding saline) were the most frequently used opioids and laxatives. Overall prior use of opioids ranged from 91.9% to 99.6% and overall prior use of laxatives ranged from 69.9% to 92.4%. Up to 77.7% had prior use of medications with interaction potential, and up to 44.5% used them concurrently with naloxegol. Naloxegol was discontinued by 55.1%–90.9% of users, typically during the first 30 days. Approximately 10%–30% switched to or augmented the treatment with another constipation medication or restarted naloxegol after discontinuation. Augmentation with another constipation medication was relatively common, suggesting that naloxegol was used for multifactorial constipation.ConclusionThe present study reflects real‐world clinical use of naloxegol, including in vulnerable patient groups. Some naloxegol users lacked laxative or regular opioid use within six months before index date or used naloxegol concomitantly with medications presenting an interaction potential.

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“…In recent years, newer symptom control drugs have come into more widespread use, leading to increased health care spending, 3 despite narrow indications and sometimes limited benefits of these drugs over existing, predominately generic drugs. 4 One example is peripheral μ-opioid receptor antagonists (PAMORAs) for opioid-induced constipation.…”

Section: Introductionmentioning

confidence: 99%

“…Medicare Part D spending on PAMORAs increased from $13.6 million USD to more than $150 million USD between 2014 and 2018. 3 Adding to patient-level financial toxicity, clinicians often prescribe symptom control drugs urgently in response to a symptom crisis, at a time when arranging financial support is either not considered or not feasible. For example, when a patient with cancer is actively vomiting, they need an urgent supply of antiemetics without the opportunity to consider whether a savings card, a generic formulation of the same drug, or an alternative (but reasonable) drug could provide substantial savings.…”

Section: Introductionmentioning

confidence: 99%

Financial Burden of Drugs Prescribed for Cancer-Associated Symptoms

Gupta

Nshuti

Grewal

et al. 2022

JCO Oncology Practice

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PURPOSE: The financial toxicity of anticancer drugs is well-documented, but little is known about the costs of drugs used to manage cancer-associated symptoms. METHODS: We reviewed relevant guidelines and compiled drugs used to manage seven cancer-associated symptoms (anorexia and cachexia, chemotherapy-induced peripheral neuropathy, constipation, diarrhea, exocrine pancreatic insufficiency, cancer-associated fatigue, and chemotherapy-induced nausea and vomiting). Using GoodRx website, we identified the retail price (cash price at retail pharmacies) and lowest price (discounted, best-case scenario of out-of-pocket costs) for patients without insurance for each drug or formulation for a typical fill. We describe lowest prices here. RESULTS: For anorexia and cachexia, costs ranged from $5 US dollars (USD; generic olanzapine or mirtazapine tablets) to $1,156 USD (brand-name dronabinol solution) and varied widely by formulation of the same drug or dosage: for olanzapine 5 mg, $5 USD (generic tablet) to $239 USD (brand-name orally disintegrating tablet). For chemotherapy-induced peripheral neuropathy, costs of duloxetine varied from $12 USD (generic) to $529 USD (brand-name). For constipation, the cost of sennosides or polyethylene glycol was <$15 USD, whereas newer agents such as methylnaltrexone were expensive ($1,001 USD). For diarrhea, the cost of generic loperamide or diphenoxylate-atropine tablets was <$15 USD. For exocrine pancreatic insufficiency, only brand-name formulations were available, range of cost, $1,072 USD-$1,514 USD. For cancer-associated fatigue, the cost of generic dexamethasone or dexmethylphenidate was <$15 USD, whereas brand-name modafinil was more costly ($1,284 USD). For a 4-drug nausea and vomiting prophylaxis regimen, costs ranged from $181 USD to $1,430 USD. CONCLUSION: We highlight the high costs of many symptom control drugs and the wide variation in the costs of these drugs. These findings can guide patient-clinician discussions about cost-effectively managing symptoms, while promoting the use of less expensive formulations when possible.

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Use of Peripheral μ-Opioid Receptor Antagonists for Treating Opioid-Induced Constipation among US Medicare Beneficiaries from 2014 to 2018

Cited by 5 publications

References 9 publications

Payer-Imposed Quantity Limits for Antiemetics: Everybody Hurts

Payer-Imposed Quantity Limits for Antiemetics: Everybody Hurts

An observational post‐authorization safety study (PASS) of naloxegol drug utilization in four European countries

Financial Burden of Drugs Prescribed for Cancer-Associated Symptoms

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