Top

Published in:

Open Access 01-11-2019 | Naloxegol | Original Article

Opioid-induced bowel dysfunction: suggestions from a multidisciplinary expert Board

Authors: Marco Rossi, Giuseppe Casale, Danilo Badiali, Federica Aielli, Maria Antonietta Aloe Spiriti, Roberto Arcioni, Francesca Bordin, Maurizio Ferrara, Gloria Morelli Sbarra, Antonio Corcione, Franco Marinangeli, Paolo Marchetti

Published in: Supportive Care in Cancer | Issue 11/2019

Abstract

Constipation, one of the adverse effects of opioid therapy with a major impact on quality of life, is still an unmet need for cancer patients, particularly those with an advanced and progressive disease, and for non-cancer patients chronically treated with opioids. The awareness of this condition is poor among healthcare providers, despite the recent publication of guidelines and consensus conferences. An early multidisciplinary approach of opioid-induced bowel dysfunction (OIBD), based on available therapies of proven effectiveness, could support clinicians in managing this condition, thus increasing patients’ adherence to pain therapy. Several Italian experts involved in the management of patients suffering from pain (anaesthesia pain therapy, oncology, haematology, palliative care, gastroenterology) joined in a Board in order to draw up an expert opinion on OIBD. The most frequent and still unsolved issues in this field were examined, including a more comprehensive definition of OIBD, the benefits of early intervention to prevent its occurrence and the most appropriate use of peripherally acting mu-opioid receptor antagonists (PAMORAs). The use of the recently introduced PAMORA naloxegol was analysed, in light of the current literature. The Board proposed a solution for each open issue in the form of recommendations, integrated with the contribution of representatives from different disciplines and often accompanied by procedural algorithms immediately usable and applicable in daily clinical practice. Safety and quality of life of the patient suffering from pain and from the adverse effects of pain therapies have been the mainstays of this expert opinion, in cooperation with general practitioners and caregivers.

Epstein R, Teagarden JR, Cimen A, Sostek M, Salimi T (2017) When people with opioid-induced constipation speak: a patient survey. Adv Ther 34:725–731. https://doi.org/10.1007/s12325-017-0480-4 CrossRefPubMedPubMedCentral

Camilleri M, Drossman DA, Becker G, Webster LR, Davies AN, Mawe GM (2014) Emerging treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid-induced constipation. Neurogastroenterol Motil 26:1386–1395. https://doi.org/10.1111/nmo.12417 CrossRefPubMedPubMedCentral

Mozaffari S, Nikfar S, Abdollahi M (2018) Investigational opioid antagonists for treating opioid-induced bowel dysfunction. Expert Opin Investig Drugs 27:235–242. https://doi.org/10.1080/13543784.2018.1420778 CrossRefPubMed

Argoff CE, Brennan MJ, Camilleri M, Davies A, Fudin J, Galluzzi KE, Gudin J, Lembo A, Stanos SP, Webster LR (2015) Consensus recommendations on initiating prescription therapies for opioid-induced constipation. Pain Med 16:2324–2337. https://doi.org/10.1111/pme.12937 CrossRefPubMedPubMedCentral

Poitras R, Warren D, Oyogoa S (2018) Opioid drugs and stercoral perforation of the colon: case report and review of literature. Int J Surg Case Rep 42:94–97. https://doi.org/10.1016/j.ijscr.2017.11.060 CrossRefPubMed

Gillett J, Ientile C, Hiscock J, Plank A, Martin JM (2012) Complementary and alternative medicine use in radiotherapy: what are patients using? J Altern Complement Med 18:1014–1020. https://doi.org/10.1089/acm.2011.0334 CrossRefPubMed

Drewes AM, Munkholm P, Simrén M, Breivik H, Kongsgaard UE, Hatlebakk JG, Agreus L, Friedrichsen M, Christrup LL (2016) Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction-recommendations of the Nordic Working Group. Scand J Pain 11:111–122. https://doi.org/10.1016/j.sjpain.2015.12.005 CrossRefPubMed

O’Brien T, Christrup LL, Drewes AM, Fallon MT, Kress HG, McQuay HJ, Mikus G, Morlion BJ, Perez-Cajaraville J, Pogatzki-Zahn E, Varrassi G, Wells JC (2017) European Pain Federation position paper on appropriate opioid use in chronic pain management. Eur J Pain 21:3–19. https://doi.org/10.1002/ejp.970 CrossRefPubMed

National Clinical Effectiveness Committee (2015) Management of constipation in adult patients receiving palliative care. National Clinical Guideline no. 10. Dublin: Department of Health. https://health.gov.ie/wp-content/uploads/2015/11/Mgmt-of-Constipation-Guideline.pdf Accessed 13 May 2018

10.

Knowles CH, Eccersley AJ, Scott SM, Walker SM, Reeves B, Lunniss PJ (2000) Linear discriminant analysis of symptoms in patients with chronic constipation: validation of a new scoring system (KESS). Dis Colon Rectum 43:1419–1426. https://doi.org/10.1016/S0016-5085(00)80553-3 CrossRefPubMed

11.

Tack J, Müller-Lissner S, Stanghellini V, Boeckxstaens G, Kamm MA, Simren M, Galmiche JP, Fried M (2011) Diagnosis and treatment of chronic constipation - a European perspective. Neurogastroenterol Motil 23:697–710. https://doi.org/10.1111/j.1365-2982.2011.01709.x CrossRefPubMedPubMedCentral

12.

Müller-Lissner S, Bassotti G, Coffin B, Drewes AM, Breivik H, Eisenberg E, Emmanuel A, Laroche F, Meissner W, Morlion B (2017) Opioid-induced constipation and bowel dysfunction: a clinical guideline. Pain Med 18:1837–1863. https://doi.org/10.1093/pm/pnw255 CrossRefPubMed

13.

Larkin PJ, Sykes NP, Centeno C, Ellershaw JE, Elsner F, Eugene B, Gootjes JR, Nabal M, Noguera A, Ripamonti C, Zucco F, Zuurmond WW, European Consensus Group on Constipation in Palliative Care (2008) The management of constipation in palliative care: clinical practice recommendations. Palliat Med 22:796–807. https://doi.org/10.1177/0269216308096908 CrossRefPubMed

14.

Panchal SJ, Müller-Schwefe P, Wurzelmann JI (2007) Opioid-induced bowel dysfunction: prevalence, pathophysiology and burden. Int J Clin Pract 61:1181–1187. https://doi.org/10.1111/j.1742-1241.2007.01415.x CrossRefPubMedPubMedCentral

15.

Wald A (2016) Constipation: advances in diagnosis and treatment. JAMA 315:185–191. https://doi.org/10.1001/jama.2015.16994 CrossRefPubMed

16.

Nelson AD, Camilleri M (2016) Opioid-induced constipation: advances and clinical guidance. Ther Adv Chronic Dis 7:121–134. https://doi.org/10.1177/2040622315627801 CrossRefPubMedPubMedCentral

17.

Blumenthal DK, Garrison JC (2011) Pharmadynamics: molecular mechanisms of drug action. In: Brunton LL, Chabner BA, Knollmann BC (eds) Goodman and Gilman’s the pharmacological basis of therapeutics. McGraw-Hill, New York, pp 41–72

18.

Bellini M, Usai-Satta P, Bove A, Bocchini R, Galeazzi F, Battaglia E, Alduini P, Buscarini E, Bassotti G, ChroCoDiTE Study Group, AIGO (2017) Chronic constipation diagnosis and treatment evaluation: the “CHRO.CO.DI.T.E.” study. BMC Gastroenterol 17:11. https://doi.org/10.1186/s12876-016-0556-7 CrossRefPubMedPubMedCentral

19.

Stanghellini V, Bellacosa L, Cogliandro R (2013) Fiber and macrogol in the therapy of chronic constipation. Minerva Gastroenterol Dietol 59:217–230PubMed

20.

Wirz S, Klaschik E (2005) Management of constipation in palliative care patients undergoing opioid therapy: is polyethylene glycol an option? Am J Hosp Palliat Care 22:375–381. https://doi.org/10.1177/104990910502200511 CrossRefPubMed

21.

Abell TL, Bernstein RK, Cutts T, Farrugia G, Forster J, Hasler WL, McCallum RW, Olden KW, Parkman HP, Parrish CR, Pasricha PJ, Prather CM, Soffer EE, Twillman R, Vinik AI (2006) Treatment of gastroparesis: a multidisciplinary clinical review. Neurogastroenterol Motil 18:263–283. https://doi.org/10.1111/j.1365-2982.2006.00760.x CrossRefPubMed

22.

Sloots CE, Rykx A, Cools M, Kerstens R, De Pauw M (2010) Efficacy and safety of prucalopride in patients with chronic noncancer pain suffering from opioid-induced constipation. Dig Dis Sci 55:2912–2921. https://doi.org/10.1007/s10620-010-1229-y CrossRefPubMedPubMedCentral

23.

Serrano-Falcón B, Rey E (2017) The safety of available treatments for chronic constipation. Expert Opin Drug Saf 16:1243–1253. https://doi.org/10.1080/14740338.2017.1361402 CrossRefPubMed

24.

Brock C, Olesen SS, Olesen AE, Frøkjaer JB, Andresen T, Drewes AM (2012) Opioid-induced bowel dysfunction: pathophysiology and management. Drugs 72:1847–1865. https://doi.org/10.2165/11634970-000000000-00000 CrossRefPubMed

25.

Michna E, Cheng WY, Korves C, Birnbaum H, Andrews R, Zhou Z, Joshi AV, Schaaf D, Mardekian J, Sheng M (2014) Systematic literature review and meta-analysis of the efficacy and safety of prescription opioids, including abuse-deterrent formulations, in non-cancer pain management. Pain Med 15:79–92. https://doi.org/10.1111/pme.12233 CrossRefPubMed

26.

Anantharamu T, Sharma S, Gupta AK, Dahiya N, Singh Brashier DB, Sharma AK (2015) Naloxegol: first oral peripherally acting mu opioid receptor antagonists for opioid-induced constipation. J Pharmacol Pharmacother 6:188–192. https://doi.org/10.4103/0976-500X.162015 CrossRefPubMedPubMedCentral

27.

Mercadante S, Porzio G, Ferrera P, Fulfaro F, Aielli F, Ficorella C, Verna L, Tirelli W, Villari P, Arcuri E (2006) Low morphine doses in opioid-naive cancer patients with pain. J Pain Symptom Manag 31:242–247. https://doi.org/10.1016/j.jpainsymman.2006.01.001 CrossRef

28.

Boland JW, Boland EG (2017) Pharmacological therapies for opioid-induced constipation in adults with cancer. BMJ 358:j3313. https://doi.org/10.1136/bmj.j3313 CrossRefPubMed

29.

Chey WD, Webster L, Sostek M, Lappalainen J, Barker PN, Tack J (2014) Naloxegol for opioid-induced constipation in patients with noncancer pain. N Engl J Med 370:2387–2396. https://doi.org/10.1056/NEJMoa1310246 CrossRefPubMed

30.

Kamm MA, Mueller-Lissner S, Wald A, Richter E, Swallow R, Gessner U (2011) Oral bisacodyl is effective and well-tolerated in patients with chronic constipation. Clin Gastroenterol Hepatol 9:577–583. https://doi.org/10.1016/j.cgh.2011.03.026 CrossRefPubMed

31.

Passmore AP, Davies KW, Flanagan PG, Stoker C, Scott MG (1993) A comparison of Agiolax and lactulose in elderly patients with chronic constipation. Pharmacology 47:249–252. https://doi.org/10.1159/000139865 CrossRefPubMed

32.

Wolff RF, Aune D, Truyers C, Hernandez AV, Misso K, Riemsma R, Kleijnen J (2012) Systematic review of efficacy and safety of buprenorphine versus fentanyl or morphine in patients with chronic moderate to severe pain. Curr Med Res Opin 28:833–845. https://doi.org/10.1185/03007995.2012.678938 CrossRefPubMed

33.

Webster L, Dhar S, Eldon M, Masuoka L, Lappalainen J, Sostek M (2013) A phase 2, double-blind, randomized, placebo-controlled, dose-escalation study to evaluate the efficacy, safety, and tolerability of naloxegol in patients with opioid-induced constipation. Pain 154:1542–1550. https://doi.org/10.1016/j.pain.2013.04.024 CrossRefPubMed

34.

Webster L, Chey WD, Tack J, Lappalainen J, Diva U, Sostek M (2014) Randomised clinical trial: the long-term safety and tolerability of naloxegol in patients with pain and opioid-induced constipation. Aliment Pharmacol Ther 40:771–779. https://doi.org/10.1111/apt.12899 CrossRefPubMed

35.

Pergolizzi JV Jr, Raffa RB, Pappagallo M, Fleischer C, Pergolizzi J 3rd, Zampogna G, Duval E, Hishmeh J, LeQuang JA, Taylor R Jr (2017) Peripherally acting μ-opioid receptor antagonists as treatment options for constipation in noncancer pain patients on chronic opioid therapy. Patient Prefer Adherence 11:107–119. https://doi.org/10.2147/PPA.S78042 CrossRefPubMedPubMedCentral

36.

Weber HC (2016) Opioid-induced constipation in chronic noncancer pain. Curr Opin Endocrinol Diabetes Obes 23:11–17. https://doi.org/10.1097/MED.0000000000000220 CrossRefPubMed

37.

Dimidi E, Christodoulides S, Scott SM, Whelan K (2017) Mechanisms of action of probiotics and the gastrointestinal microbiota on gut motility and constipation. Adv Nutr 8:484–494. https://doi.org/10.3945/an.116.014407 CrossRefPubMedPubMedCentral

38.

Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG (2014) A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 146:67–75.e5. https://doi.org/10.1053/j.gastro.2013.09.046 CrossRefPubMed

39.

Bui K, Zhou D, Xu H, Floettmann E, Al-Huniti N (2017) Clinical pharmacokinetics and pharmacodynamics of naloxegol, a peripherally acting μ-opioid receptor antagonist. Clin Pharmacokinet 56:573–582. https://doi.org/10.1007/s40262-016-0479-z CrossRefPubMed

40.

Garnock-Jones KP (2015) Naloxegol: a review of its use in patients with opioid-induced constipation. Drugs 75:419–425. https://doi.org/10.1007/s40265-015-0357-2 CrossRefPubMed

41.

Bui K, She F, Sostek M (2014) The effects of renal impairment on the pharmacokinetics, safety, and tolerability of naloxegol. J Clin Pharmacol 54:1375–1382. https://doi.org/10.1002/jcph.349 CrossRefPubMed

42.

Lawson R, King F, Marsh K, Altincatal A, Cimen A (2016) Impact of treatment with naloxegol for opioid-induced constipation on patients’ health state utility. Adv Ther 33:1331–1346. https://doi.org/10.1007/s12325-016-0365-y CrossRefPubMedPubMedCentral

43.

Müller-Busch HC, Lindena G, Tietze K, Woskanjan S (2005) Opioid switch in palliative care, opioid choice by clinical need and opioid availability. Eur J Pain 9:571–579. https://doi.org/10.1016/j.ejpain.2004.12.003 CrossRefPubMed

44.

Bruner HC, Atayee RS, Edmonds KP, Buckholz GT (2015) Clinical utility of naloxegol in the treatment of opioid-induced constipation. J Pain Res 8:289–294. https://doi.org/10.2147/JPR.S61326 CrossRefPubMedPubMedCentral

45.

Ueberall MA, Mueller-Schwefe GH (2015) Safety and efficacy of oxycodone/naloxone vs. oxycodone vs. morphine for the treatment of chronic low back pain: results of a 12 week prospective, randomized, open-label blinded endpoint streamlined study with prolonged-release preparations. Curr Med Res Opin 31:1413–1429. https://doi.org/10.1185/03007995.2015.1047747 CrossRefPubMed

Title: Opioid-induced bowel dysfunction: suggestions from a multidisciplinary expert Board
Authors: Marco Rossi
Giuseppe Casale
Danilo Badiali
Federica Aielli
Maria Antonietta Aloe Spiriti
Roberto Arcioni
Francesca Bordin
Maurizio Ferrara
Gloria Morelli Sbarra
Antonio Corcione
Franco Marinangeli
Paolo Marchetti
Publication date: 01-11-2019
Publisher: Springer Berlin Heidelberg
Keywords: Naloxegol
Constipation
Opioids
Opioids
Oxycodone-Naloxone
Constipation
Published in: Supportive Care in Cancer / Issue 11/2019
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-019-04688-2

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 11/2019

Spiritual well-being mediates the association between attachment insecurity and psychological distress in advanced cancer patients

Patient navigation for complex care patients in the emergency department: a survey of oncology patient navigators

Symptom frequency and change of oldest old cancer patients

Body changes after cancer: female cancer patients’ perceived social support and their perspective on care

Depression as mediator and or moderator on the relationship between hopelessness and patients’ desire for hastened death

Patient-reported outcomes from a workplace intervention program for cancer survivors highlight ongoing needs to support continuation of work

Keynote webinar | Spotlight on antibody–drug conjugates in cancer