DECEMBER 11, 2023
Patients with cancer and opioid-induced constipation (OIC) achieved rescue-free laxation within four to 24 hours of initial dose of methylnaltrexone, according to a study in the Journal of Pain Research (2023;16:3529-3543).
The investigators analyzed two randomized, double-blind, placebo-controlled studies of 363 patients who received subcutaneous methylnaltrexone or placebo every other day for two weeks. Stratified by baseline age, Eastern Cooperative Oncology Group (ECOG) Performance Status
Patients with cancer and opioid-induced constipation (OIC) achieved rescue-free laxation within four to 24 hours of initial dose of methylnaltrexone, according to a study in the Journal of Pain Research (2023;16:3529-3543).
The investigators analyzed two randomized, double-blind, placebo-controlled studies of 363 patients who received subcutaneous methylnaltrexone or placebo every other day for two weeks. Stratified by baseline age, Eastern Cooperative Oncology Group (ECOG) Performance Status and cancer status, laxative type, and opioid requirement, the study found “a significantly greater proportion of patients receiving methylnaltrexone versus placebo achieved rescue-free laxation within four hours.”
“In prior clinical trials, methylnaltrexone demonstrated superior efficacy over placebo in achieving rescue-free laxation,” said lead author Neel Mehta, MD, the director of pain medicine at NewYork-Presbyterian/Weill Cornell Medical Center, in New York City. “We went one step further, analyzing whether age and cancer status influence the likelihood a patient will respond to methylnaltrexone.”
Limitations cited by the study include analyses not designed to compare subgroups stratified by baseline characteristics and short duration of the trials, a result of the advanced illness of the patients. This “may have significantly affected the occurrence of treatment emergent adverse events (TEAEs),” states the study, which notes most patients experienced TEAEs, especially abdominal pain among those treated with methylnaltrexone.
“Patients with cancer had a slightly higher incidence of TEAEs. Abdominal pain decreased with repeated doses of medication,” Mehta said.
He advises pain physicians to recognize side effects of opioids among those with advanced illness and cancer. “Discuss bowel habits for those using opioids for pain, and feel confident in using methylnaltrexone where appropriate regardless of age, ECOG performance status and cancer status.”
—PMN Staff
