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Gudin J, Rauck R, Argoff C, Agaiby E, Gimbel J, Katz N, Doberstein SK, Tagliaferri M, Tagliaferri M, Potts J, Wild J, Lu L, Siddhanti S, Hale M, Markman J. Long-term Safety and Tolerability of NKTR-181 in Patients with Moderate to Severe Chronic Low Back Pain or Chronic Noncancer Pain: A Phase 3 Multicenter, Open-Label, 52-Week Study (SUMMIT-08 LTS). PAIN MEDICINE 2021; 21:1347-1356. [PMID: 31361019 PMCID: PMC7372935 DOI: 10.1093/pm/pnz169] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the long-term safety of NKTR-181, a novel mu-opioid receptor agonist that may have reduced human abuse potential, in patients with moderate to severe chronic low back pain (CLBP) or other chronic noncancer pain (CNP). DESIGN Uncontrolled, multicenter, open-label, long-term study of NKTR-181 comprised of three periods: screening (≤21 days), treatment (52 weeks), and safety follow-up (∼14 days after the last dose of NKTR-181). SETTING Multicenter, long-term clinical research study. METHODS NKTR-181 administered at doses of 100-600 mg twice daily (BID) was evaluated in opioid-naïve and opioid-experienced patients. Patients were enrolled de novo or following completion of the randomized, placebo-controlled phase 3 efficacy study (SUMMIT-07). Safety assessments included adverse event documentation, measurements of opioid withdrawal, and clinical laboratory tests. Effectiveness was assessed using the modified Brief Pain Inventory Short Form (mBPI-SF). RESULTS The study enrolled 638 patients. The most frequently reported treatment-emergent adverse events (TEAEs) were constipation (26%) and nausea (12%). Serious TEAEs, reported in 5% of patients, were deemed by investigators to be unrelated to NKTR-181. There were no deaths or reported cases of respiratory depression. A sustained reduction in mBPI-SF pain intensity and pain interference from baseline to study termination was observed throughout treatment. Only 2% of patients discontinued NKTR-181 due to lack of efficacy, and 11% discontinued due to treatment-related AEs. NKTR-181 doses of up to 600 mg BID were generally well tolerated, and patients experienced low rates of opioid-related adverse events. CONCLUSIONS The study results support the premise that NKTR-181 is a safe and effective option for patients with moderate to severe CLBP or CNP.
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Affiliation(s)
- Jeffrey Gudin
- *Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey.,Pain Management and Wellness Center, Englewood, New Jersey
| | - Richard Rauck
- Carolinas Pain Institute and The Center for Clinical Research, Winston-Salem, North Carolina
| | - Charles Argoff
- Department of Neurology, Albany Medical Center, Albany, New York
| | - Eva Agaiby
- Clinical Investigation Specialists Inc, Kenosha, Wisconsin
| | | | - Nathaniel Katz
- Tufts University School of Medicine, Boston, Massachusetts.,**Analgesic Solutions, Wayland, Massachusetts
| | | | | | | | | | - James Wild
- Upstate Clinical Research Associates, Williamsville, New York
| | - Lin Lu
- Nektar Therapeutics, San Francisco, California
| | | | - Martin Hale
- Gold Coast Research, LLC, Plantation, Florida
| | - John Markman
- Department of Neurosurgery, Translational Pain Research Program, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Abstract
BACKGROUND AND AIMS Patients with Crohn's disease (CD) are often prescribed opioids chronically to manage pain associated with their disease. However, little evidence exists to support this practice. Here, we examine newly diagnosed patients with CD with and without chronic opioid use (COU) and sought to identify predictors and consequences of COU. METHODS A nationally representative administrative health care claims that data set identified newly diagnosed patients with CD. Their data were examined during the periods 6 months before and 2 years after diagnosis. Multivariable logistic regression was used to assess predictors of COU at diagnosis. RESULTS The final study cohort consisted of 47,164 patients with CD. Of them, 3.8% were identified with new COU. Chronic opioid users were more likely women, older, and likely who had more surgeries, endoscopies, admissions, and medication usage compared with other patients. Features detected before CD diagnosis that correlated with COU after diagnosis included previous opioid use (odds ratio [OR] = 6.6), chronic pain (OR = 1.36), arthritis (OR = 1.95), and mental disorders (OR = 1.58). Interestingly, emergency department visits before CD Dx increased the risk of COU (OR = 1.11), whereas endoscopy reduced COU risk (OR = 0.88). CONCLUSIONS This study presents a nationally representative assessment of COU in newly diagnosed patients with CD. The results may be used to determine the impact of COU in this population and to alert clinicians to those patients with CD at high risk of COU. Chronic opioids are consistently associated with indicators of more severe disease; however, additional research is needed to determine whether COU drives disease severity or vice versa.
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Convertino M, Samoshkin A, Gauthier J, Gold MS, Maixner W, Dokholyan NV, Diatchenko L. μ-Opioid receptor 6-transmembrane isoform: A potential therapeutic target for new effective opioids. Prog Neuropsychopharmacol Biol Psychiatry 2015; 62:61-7. [PMID: 25485963 PMCID: PMC4646084 DOI: 10.1016/j.pnpbp.2014.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 11/04/2014] [Accepted: 11/20/2014] [Indexed: 01/19/2023]
Abstract
The μ-opioid receptor (MOR) is the primary target for opioid analgesics. MOR induces analgesia through the inhibition of second messenger pathways and the modulation of ion channels activity. Nevertheless, cellular excitation has also been demonstrated, and proposed to mediate reduction of therapeutic efficacy and opioid-induced hyperalgesia upon prolonged exposure to opioids. In this mini-perspective, we review the recently identified, functional MOR isoform subclass, which consists of six transmembrane helices (6 TM) and may play an important role in MOR signaling. There is evidence that 6 TM MOR signals through very different cellular pathways and may mediate excitatory cellular effects rather than the classic inhibitory effects produced by the stimulation of the major (7 TM) isoform. Therefore, the development of 6 TM and 7 TM MOR selective compounds represents a new and exciting opportunity to better understand the mechanisms of action and the pharmacodynamic properties of a new class of opioids.
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Affiliation(s)
- Marino Convertino
- Biochemistry and Biophysics Department, University of North Carolina, 120 Mason Farm Rd., CB #7260 Genetic Medicine, Chapel Hill, NC, USA, 27599
| | - Alexander Samoshkin
- The Alan Edwards Centre for Research on Pain, McGill University, 740 Dr. Penfield Avenue, Montreal, Quebec, Canada, H3A 0G1
| | - Josee Gauthier
- Center for Pain Research and Innovation, University of North Carolina, 385 S. Columbia St., CB #7455, KOHSB, Chapel Hill, NC, USA, 27599
| | - Michael S. Gold
- Department of Anesthesiology, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA, USA 15213
| | - William Maixner
- Center for Pain Research and Innovation, University of North Carolina, 385 S. Columbia St., CB #7455, KOHSB, Chapel Hill, NC 27599, USA.
| | - Nikolay V. Dokholyan
- Biochemistry and Biophysics Department, University of North Carolina, 120 Mason Farm Rd., CB #7260 Genetic Medicine, Chapel Hill, NC, USA, 27599.,CORRESPONDING AUTHORS: Dr. Luda Diatchenko, The Alan Edwards Centre for Research on Pain, McGill University, 740 Dr. Penfield Avenue, Montreal, Quebec, Canada, H3A 0G1, Phone: +1 514 398-2878, . Dr. William Maixner, Center for Pain Research and Innovation, University of North Carolina, 385 S. Columbia St., CB #7455, KOHSB, Chapel Hill, NC, USA, 27599, Phone: +1 919 537-3289, . Dr. Nikolay V. Dokholyan, Biochemistry and Biophysics Department, University of North Carolina, 120 Mason Farm Rd., CB #7260 Genetic Medicine, Chapel Hill, NC, USA, 27599, Phone: +1 919 843-2513.
| | - Luda Diatchenko
- The Alan Edwards Centre for Research on Pain, McGill University, 740 Dr. Penfield Avenue, Montreal, Quebec H3A 0G1, Canada.
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