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Nishiba H, Imai H, Fujita Y, Hiruta E, Masuno T, Yamazaki S, Tanaka H, Kamiya T, Ito M, Takei S, Matsuura M, Mogi J, Minato K, Obayashi K. Efficacy and Safety of Naldemedine for Patients with Cancer with Opioid-Induced Constipation in Clinical Practice: A Real-World Retrospective Study. J Clin Med 2022; 11:jcm11092672. [PMID: 35566798 PMCID: PMC9102706 DOI: 10.3390/jcm11092672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/21/2022] [Accepted: 05/05/2022] [Indexed: 12/25/2022] Open
Abstract
The efficacy and safety of naldemedine for opioid-induced constipation in patients with cancer has not been investigated in clinical practice. We conducted a multicenter, retrospective study to assess the effects of naldemedine among 10 Japanese institutions between June 2017 and August 2019. We evaluated the number of defecations 7 days before and after naldemedine administration. A total of 149 patients (89 male) with a median age of 72 years (range, 38−96) were included. The performance status was 0−1, 2, and ≥3 in 40, 38, and 71 patients, respectively. The median opioid dose in oral morphine equivalents was 30 mg/day (range: 7.5−800 mg). We observed 98 responders and 51 non-responders. The median number of defecations increased significantly in the 7 days following naldemedine administration from three to six (p < 0.0001). Multivariate analysis revealed that an opioid dose <30 mg/day [odds ratio, 2.08; 95% confidence interval, 1.01−4.32; p = 0.042] was significantly correlated with the effect of naldemedine. Diarrhea was the most common adverse event (38.2%) among all grades. The efficacy and safety of naldemedine in clinical practice are comparable to those of prospective studies, suggesting that it is effective in most patients.
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Affiliation(s)
- Hiromi Nishiba
- Division of Pharmacy, Japan Community Health Care Organization (JCHO) Gunma Chuo Hospital, 1-7-13, Kouun, Maebashi 371-0025, Gunma, Japan;
- Graduate School of Pharmaceutical Sciences, Takasaki University of Health and Welfare, 37-1, Nakaorui, Takasaki 370-0033, Gunma, Japan;
| | - Hisao Imai
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka 350-1298, Saitama, Japan
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashi-nishi, Ota 373-8550, Gunma, Japan;
- Correspondence: ; Tel.: +81-42-984-4111; Fax: +81-42-984-4741
| | - Yukiyoshi Fujita
- Division of Pharmacy, Gunma Prefectural Cancer Center, 617-1, Takahayashi-nishi, Ota 373-8550, Gunma, Japan; (Y.F.); (E.H.)
| | - Eriko Hiruta
- Division of Pharmacy, Gunma Prefectural Cancer Center, 617-1, Takahayashi-nishi, Ota 373-8550, Gunma, Japan; (Y.F.); (E.H.)
| | - Takashi Masuno
- Division of Pharmacy, Fujioka General Hospital, 813-1, Nakagurisu, Fujioka 375-8503, Gunma, Japan;
| | - Shigeki Yamazaki
- Division of Pharmacy, Kiryu Kosei General Hospital, 6-3, Orihime, Kiryu 376-0024, Gunma, Japan;
| | - Hajime Tanaka
- Division of Pharmacy, Haramachi Red Cross Hospital, 698, Haramachi, Higashiagatsuma-machi, Agatsuma-gun 377-0882, Gunma, Japan;
| | - Teruhiko Kamiya
- Department of Pharmacy, Tatebayashi Kosei General Hospital, 262-1, Narushima, Tatebayashi 374-8533, Gunma, Japan;
| | - Masako Ito
- Division of Pharmacy, Ota Memorial Hospital, 455-1, Oshima, Ota 373-8585, Gunma, Japan;
| | - Satoshi Takei
- Division of Pharmacy, Tone Central Hospital, 910-1, Numasu, Numata 378-0012, Gunma, Japan;
| | - Masato Matsuura
- Division of Pharmacy, Gunma Saiseikai Maebashi Hospital, 564-1, Kamishinden, Maebashi 371-0821, Gunma, Japan;
| | - Junnosuke Mogi
- Division of Pharmacy, Hidaka Hospital, 886, Nakao, Takasaki 370-0001, Gunma, Japan;
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashi-nishi, Ota 373-8550, Gunma, Japan;
| | - Kyoko Obayashi
- Graduate School of Pharmaceutical Sciences, Takasaki University of Health and Welfare, 37-1, Nakaorui, Takasaki 370-0033, Gunma, Japan;
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Urits I, Patel A, Kiernan HC, Clay CJ, Monteferrante N, Jung JW, Berger AA, Kassem H, Hasoon J, Kaye AD, Kaye AM, Viswanath O. Naldemedine for the Use of Management of Opioid Induced Constipation. PSYCHOPHARMACOLOGY BULLETIN 2020; 50:97-118. [PMID: 32733114 PMCID: PMC7377540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE OF REVIEW Opioid medications are a pillar of acute and chronic analgesia, though their use is often accompanied by side-effects, such as opioid-induced constipation. Unfortunately, tolerance rarely develops to this untoward side effect. This review presents the background, evidence, and indications for the use of Naldemedine (Brand name Symproic 0.2 mg tablets) to treat opioid-induced constipation. RECENT FINDINGS Opioids are often used for the treatment of acute and chronic analgesia. Outside of the central effect they exert, they also interact with peripheral receptors, resulting in opioid-induced constipation, the commonest of side effects of chronic opioid usage. Complications include colonic distention, ileus, perforation, and can progress to other serious bowel complications, which can result in hospitalization and fatal events.For the most part, laxatives and other anti-constipation therapies are often inefficient and require intervention directed at the root cause, such as peripheral mu receptor agonists, including methylnaltrexone, naloxegol, and naldemedine. Naldemedine is the most recent to gain FDA approval of the group.An antagonist of Mu, Kappa, and Delta peripheral receptors, Naldemedine, is the only drug to counteract all three receptor classes. It was shown to be both safe and effective when compared with placebo. No data exists to compare its efficacy to that of other members of the group. SUMMARY Opioids are frequently used in the management of acute and chronic pain. The most common of the side effects is opioid-induced constipation, secondary to the peripheral activity of opioids. Naldemedine is an FDA-approved, once-daily oral tablet that counteracts this side effect by antagonizing mu, kappa, and delta-opioid receptors and has been shown to be safe and effective. Further investigation including head-to-head clinical trials are required to evaluate the relative efficacy of naldemedine compare with other peripheral opiate receptor antagonists.
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Affiliation(s)
- Ivan Urits
- Urits, Berger, Hasoon, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Jung, Georgetown University School of Medicine, Washington, DC. Cornwall Kiernan, Joseph Clay, Viswanath, University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, Monteferrante, Viswanath, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Kassem, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Kaye, Viswanath, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, Viswanath, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ
| | - Anjana Patel
- Urits, Berger, Hasoon, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Jung, Georgetown University School of Medicine, Washington, DC. Cornwall Kiernan, Joseph Clay, Viswanath, University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, Monteferrante, Viswanath, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Kassem, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Kaye, Viswanath, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, Viswanath, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ
| | - Hayley Cornwall Kiernan
- Urits, Berger, Hasoon, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Jung, Georgetown University School of Medicine, Washington, DC. Cornwall Kiernan, Joseph Clay, Viswanath, University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, Monteferrante, Viswanath, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Kassem, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Kaye, Viswanath, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, Viswanath, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ
| | - Conner Joseph Clay
- Urits, Berger, Hasoon, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Jung, Georgetown University School of Medicine, Washington, DC. Cornwall Kiernan, Joseph Clay, Viswanath, University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, Monteferrante, Viswanath, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Kassem, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Kaye, Viswanath, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, Viswanath, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ
| | - Nikolas Monteferrante
- Urits, Berger, Hasoon, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Jung, Georgetown University School of Medicine, Washington, DC. Cornwall Kiernan, Joseph Clay, Viswanath, University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, Monteferrante, Viswanath, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Kassem, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Kaye, Viswanath, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, Viswanath, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ
| | - Jai Won Jung
- Urits, Berger, Hasoon, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Jung, Georgetown University School of Medicine, Washington, DC. Cornwall Kiernan, Joseph Clay, Viswanath, University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, Monteferrante, Viswanath, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Kassem, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Kaye, Viswanath, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, Viswanath, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ
| | - Amnon A Berger
- Urits, Berger, Hasoon, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Jung, Georgetown University School of Medicine, Washington, DC. Cornwall Kiernan, Joseph Clay, Viswanath, University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, Monteferrante, Viswanath, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Kassem, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Kaye, Viswanath, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, Viswanath, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ
| | - Hisham Kassem
- Urits, Berger, Hasoon, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Jung, Georgetown University School of Medicine, Washington, DC. Cornwall Kiernan, Joseph Clay, Viswanath, University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, Monteferrante, Viswanath, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Kassem, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Kaye, Viswanath, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, Viswanath, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ
| | - Jamal Hasoon
- Urits, Berger, Hasoon, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Jung, Georgetown University School of Medicine, Washington, DC. Cornwall Kiernan, Joseph Clay, Viswanath, University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, Monteferrante, Viswanath, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Kassem, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Kaye, Viswanath, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, Viswanath, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ
| | - Alan D Kaye
- Urits, Berger, Hasoon, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Jung, Georgetown University School of Medicine, Washington, DC. Cornwall Kiernan, Joseph Clay, Viswanath, University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, Monteferrante, Viswanath, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Kassem, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Kaye, Viswanath, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, Viswanath, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ
| | - Adam M Kaye
- Urits, Berger, Hasoon, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Jung, Georgetown University School of Medicine, Washington, DC. Cornwall Kiernan, Joseph Clay, Viswanath, University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, Monteferrante, Viswanath, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Kassem, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Kaye, Viswanath, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, Viswanath, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ
| | - Omar Viswanath
- Urits, Berger, Hasoon, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Jung, Georgetown University School of Medicine, Washington, DC. Cornwall Kiernan, Joseph Clay, Viswanath, University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, Monteferrante, Viswanath, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Kassem, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Kaye, Viswanath, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, Viswanath, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ
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