Efficacy of pharmacological therapies for the treatment of opioid-induced constipation: systematic review and network meta-analysis
@article{Luthra2013EfficacyOP, title={Efficacy of pharmacological therapies for the treatment of opioid-induced constipation: systematic review and network meta-analysis}, author={Pavit Luthra and Nicholas Ewin Burr and Darren M. Brenner and Alexander Charles Ford}, journal={Gut}, year={2013}, volume={68}, pages={434 - 444} }
Objective Opioids are increasingly prescribed in the West and have deleterious GI consequences. Pharmacological therapies to treat opioid-induced constipation (OIC) are available, but their relative efficacy is unclear. We performed a systematic review and network meta-analysis to address this deficit in current knowledge. Design We searched MEDLINE, EMBASE, EMBASE Classic and the Cochrane central register of controlled trials through to December 2017 to identify randomised controlled trials…
51 Citations
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This study will provide a comprehensive evidence on the effectiveness and safety of pharmacological and non-pharmacological treatments for opioid-induced constipation.
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The authors concluded that peripherally acting mu-opioid receptor antagonists (PAMORAs) and the prokinetic prucalopride were all more effective than placebo for OIC and that naloxone and naldemedine were the most efficacious ones.
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Naldemedine improves a variety of bowel function parameters while preserving analgesia, confirming its efficacy for patients with OIC, however, head-to-head trials are needed to establish naldemedines as treatment of first choice for laxative-refractory OIC.
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It is demonstrated that naldemedine appeared to benefit patients with OIC and cancer, irrespective of baseline characteristics, and did not seem to affect analgesia or withdrawal–even in patients with potential BBB disruptions.
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The authors concluded that naloxone was the best drug in patients with OIC, followed by naldemedine, and several factors impacted the appraisal of relative efficacy.
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An Italian multidisciplinary panel on the management of opioid-induced constipation (OIC) and bowel dysfunction concludes that a comprehensive prevention and management strategy for OIC should include interventions that aim to improve fibre and fluid intake, increase mobility or exercise, and restore bowel function without compromising pain control.
Naldemedine for the treatment of opioid-induced constipation in adults with chronic noncancer pain.
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Based on available data, naldemedine appears to be an effective and safe first-line therapy for the treatment of opioid-induced constipation in adults with chronic noncancer pain.
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Naldemedine has proven efficacy superior to placebo in the treatment of OIC in both cancer and non-cancer patients while improving patient-reported constipation symptoms and patients’ QoL and may be safely used in patients with renal failure and mild to moderate hepatic impairment.
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