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Shimizu M, Maeda I, Kessoku T, Ishiki H, Matsuura T, Hiratsuka Y, Matsuda Y, Hasegawa T, Imai K, Oyamada S, Satomi E. The safety and effectiveness of naldemedine for opioid-induced constipation in patients with advanced cancer in real-world palliative care settings: a multicenter prospective observational study. Support Care Cancer 2024; 32:504. [PMID: 38985364 DOI: 10.1007/s00520-024-08716-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 07/04/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE In this study, we aimed to evaluate the safety and effectiveness of naldemedine for treating opioid-induced constipation (OIC) in patients with advanced cancer, who are receiving palliative care, and particularly explored its early effects. METHODS Palliative care teams and inpatient palliative care units across 14 institutions in Japan were included in this multicenter, prospective, observational study. Patients who were newly prescribed a daily oral dose of 0.2 mg naldemedine were enrolled. The spontaneous bowel movement (SBM) within 24 h after the first dose of naldemedine was considered the primary outcome, whereas, the secondary outcomes included weekly changes in SBM frequency and adverse events. RESULTS A total of 204 patients were enrolled and 184 completed the 7-day study. The average age of the participants (103 males, 101 females) was 63 ± 14 years. The primary cancer was detected in the lungs (23.5%), gastrointestinal tract (13.7%), and urological organs (9.3%). A considerable proportion of patients (34.8%) had ECOG performance status of 3-4. Most patients were undergoing active cancer treatment, however, 40.7% of the patients were receiving the best supportive care. Within 24 h of the first naldemedine dose, 146 patients (71.6%, 95% CI: 65.4-77.8%) experienced SBMs. The weekly SBM counts increased in 62.7% of the participants. The major adverse events included diarrhea and abdominal pain, detected in 17.6% and 5.4% of the patients, respectively. However, no serious adverse events were observed. CONCLUSION Conclusively, naldemedine is effective and safe for OIC treatments in real-world palliative care settings. TRIAL REGISTRATION NUMBER UMIN000031381, registered 20/02/2018.
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Affiliation(s)
- Masaki Shimizu
- Department of Palliative Care, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Osaka, Japan.
| | - Takaomi Kessoku
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan
- Department of Palliative Medicine, International University Health and Welfare Narita Hospital, Narita, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Matsuura
- Palliative Care Center, Fujisawa Shounandai Hospital, Kanagawa, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, NHO Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Takaaki Hasegawa
- Center for Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Eriko Satomi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
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Imai H, Fujita Y, Hiruta E, Masuno T, Yamazaki S, Tanaka H, Kamiya T, Sandoh M, Takei S, Arai K, Nishiba H, Mogi J, Koizuka S, Saito T, Obayashi K, Kaira K, Minato K. Efficacy and safety of naldemedine for opioid-induced constipation in older patients with cancer: a retrospective study. Eur J Gastroenterol Hepatol 2024; 36:571-577. [PMID: 38477855 DOI: 10.1097/meg.0000000000002746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Opioids are pain relievers that are often associated with opioid-induced constipation (OIC) that worsens with age. We performed a multicenter, retrospective analysis on the efficacy and safety of naldemedine, an opioid receptor antagonist, in treating OIC in patients with cancer (age >75 years). METHODS The electronic medical records of cancer patients who received naldemedine at 10 Japanese institutions between 7 June 2017 and August 31, 2019, were retrieved. Patients aged ≥75 years who were treated with naldemedine for the first time and hospitalized for at least 7 days before and after initiating naldemedine therapy were included in this analysis. RESULTS Sixty patients were observed for at least 7 days before and after starting naldemedine. The response rate was 68.3%, and the frequency of bowel movements increased significantly after naldemedine administration in the overall population ( P < 0.0001) and among those who defecated <3 times/week before naldemedine administration ( P < 0.0001). Diarrhea was the most frequent adverse event in all grades, observed in 45% of patients, of which 92.6% were Grade 1 or 2. Grade 4 or higher adverse events, including death, were not observed. CONCLUSION Naldemedine exhibits significant efficacy and safety in OIC treatment in older patients with cancer.
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Affiliation(s)
- Hisao Imai
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center
| | | | - Eriko Hiruta
- Division of Pharmacy, Gunma Prefectural Cancer Center, Ota
| | | | | | - Hajime Tanaka
- Division of Pharmacy, Haramachi Red Cross Hospital, Agatsuma-gun
| | - Teruhiko Kamiya
- Department of Pharmacy, Tatebayashi Kosei General Hospital, Tatebayashi
| | | | | | - Kazuya Arai
- Division of Pharmacy, Gunma Saiseikai Maebashi Hospital, Maebashi
| | - Hiromi Nishiba
- Division of Pharmacy, Japan Community Health Care Organization (JCHO) Gunma Chuo Hospital, Maebashi
- Graduate School of Pharmaceutical Sciences, Takasaki University of Health and Welfare
| | - Junnosuke Mogi
- Division of Pharmacy, Hidaka Hospital. 886 Nakao, Takasaki
| | - Shiro Koizuka
- Division of Palliative Care, Gunma Prefectural Cancer Center, Ota, Gunma, Japan
| | - Taeko Saito
- Division of Pharmacy, Gunma Prefectural Cancer Center, Ota
| | - Kyoko Obayashi
- Graduate School of Pharmaceutical Sciences, Takasaki University of Health and Welfare
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center
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Fujita Y, Imai H, Hiruta E, Masuno T, Yamazaki S, Tanaka H, Kamiya T, Sandoh M, Takei S, Arai K, Nishiba H, Mogi J, Koizuka S, Saito T, Obayashi K, Kaira K, Minato K. Efficacy and Safety of Naldemedine Administration for Opioid-Induced Constipation in Cancer Patients with Poor Performance Status. J Palliat Med 2023; 26:548-553. [PMID: 36971576 DOI: 10.1089/jpm.2022.0495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background: Constipation is a concern among patients with Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 3 and 4. Objectives: To assess naldemedine's efficacy and safety in cancer patients on opioids with poor PS. Design: Multicenter, retrospective study. Setting/Subjects: Japanese cancer patients with ECOG performance status 3 or 4 who received naldemedine. Measurements: Frequency of defecations before/after naldemedine use. Responders were patients whose defecation frequency increased to ≥3 times/week, from baseline ≥1 defecations/week over seven days after naldemedine administration. Results: Seventy-one patients were analyzed; 66.1% were responders (95% confidence interval: 54.5%-76.1%). Defecation frequency increased significantly after naldemedine in the overall population (6 vs. 2, p < 0.0001) and among those who defecated <3 times/week before naldemedine (4.5 vs. 1, p < 0.0001). Diarrhea (38.0%) of all grades was the most common adverse event; 23 (85.2%) events were classified as Grade 1 or 2. Conclusion: Naldemedine is effective and safe among cancer patients with poor PS.
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Affiliation(s)
- Yukiyoshi Fujita
- Divisions of Pharmacy, Gunma Prefectural Cancer Center, Ota, Japan
| | - Hisao Imai
- Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Eriko Hiruta
- Divisions of Pharmacy, Gunma Prefectural Cancer Center, Ota, Japan
| | - Takashi Masuno
- Division of Pharmacy, Fujioka General Hospital, Fujioka, Japan
| | - Shigeki Yamazaki
- Division of Pharmacy, Kiryu Kosei General Hospital, Kiryu, Japan
| | - Hajime Tanaka
- Division of Pharmacy, Haramachi Red Cross Hospital, Agatsuma-gun, Japan
| | - Teruhiko Kamiya
- Department of Pharmacy, Tatebayashi Kosei General Hospital, Tatebayashi, Japan
| | | | - Satoshi Takei
- Division of Pharmacy, Tone Central Hospital, Numata, Japan
| | - Kazuya Arai
- Division of Pharmacy, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Hiromi Nishiba
- Division of Pharmacy, Japan Community Health Care Organization (JCHO) Gunma Chuo Hospital, Maebashi, Japan
- Laboratory of Clinical Pharmacy, Faculty of Pharmacy, Takasaki University of Health and Welfare, Takasaki, Japan
| | | | - Shiro Koizuka
- Palliative Care, Gunma Prefectural Cancer Center, Ota, Japan
| | - Taeko Saito
- Divisions of Pharmacy, Gunma Prefectural Cancer Center, Ota, Japan
| | - Kyoko Obayashi
- Laboratory of Clinical Pharmacy, Faculty of Pharmacy, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Koichi Minato
- Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
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A Retrospective Study of the Efficacy and Safety of Naldemedine for Treatment of Opioid-Induced Constipation in Patients with Hepatobiliary Pancreatic Cancer. Medicina (B Aires) 2023; 59:medicina59030492. [PMID: 36984494 PMCID: PMC10051263 DOI: 10.3390/medicina59030492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/03/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Background and Objectives: Opioid analgesics, which are used for cancer-related pain management, cause opioid-induced constipation (OIC). Naldemedine, a peripheral opioid receptor antagonist, is an OIC-modifying agent, but no focused efficacy and safety analysis has been conducted for its use in hepatobiliary pancreatic cancers. We performed a multi-institutional study on the efficacy and safety of naldemedine in patients with hepatobiliary pancreatic cancer using opioids in clinical practice. Materials and Methods: We retrospectively evaluated patients with hepatobiliary pancreatic cancer (including liver, biliary tract, and pancreatic cancers) treated with opioids and naldemedine during hospitalization at ten institutions in Japan from June 2017 to August 2019. We assessed the frequency of bowel movements before and after the initiation of naldemedine therapy. Responders were defined as patients who defecated ≥3 times/week, with an increase from a baseline of ≥1 defecations/week over seven days after the initiation of naldemedine administration. Results: Thirty-four patients were observed for one week before and one week after starting naldemedine. The frequency of bowel movements increased by one over the baseline frequency or to at least thrice per week in 21 patients. The response rate was 61.7% (95% confidence interval: 45.4–78.0%). The median number of weekly bowel movements before and after naldemedine treatment was 2 (range: 0–9) and 6 (range: 1–17), respectively, in the overall population (n = 34); the increase in the number of bowel movements following naldemedine administration was statistically significant (Wilcoxon signed-rank test, p < 0.0001). Diarrhea was the predominant gastrointestinal symptom, and 10 (29.4%) patients experienced grade 1, grade 2, or grade 3 adverse events. The only other adverse event included fatigue in one patient; grade 2–4 adverse events were absent. Conclusions: Naldemedine is effective, and its use may be safe in clinical practice for patients with hepatobiliary pancreatic cancer receiving opioid analgesics.
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Imai H, Fujita Y, Hiruta E, Masuno T, Yamazaki S, Tanaka H, Kamiya T, Sandoh M, Takei S, Arai K, Nishiba H, Mogi J, Kaira K, Minato K. A retrospective study of the efficacy and safety of naldemedine for opioid-induced constipation in thoracic cancer patients. Thorac Cancer 2022; 13:2301-2308. [PMID: 35790500 PMCID: PMC9376157 DOI: 10.1111/1759-7714.14557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 12/01/2022] Open
Abstract
Background We conducted a multicenter, retrospective study on the efficacy and safety of naldemedine in thoracic cancer patients using opioids in clinical practice. Methods We retrospectively evaluated thoracic cancer patients treated with naldemedine at 10 institutions in Japan. Clinical data of patients administered naldemedine between June 2017 and August 2019 were extracted from electronic medical records. Inclusion criteria were as follows: (i) patients hospitalized for at least seven days before and after naldemedine administration, and (ii) those whose frequency of defecation was entered in the medical records. Results Forty patients were analyzed, and defecation frequency was observed for at least seven days before and after naldemedine administration. The response rate was 65.0% (95% CI: 50.2%–79.7%). The number of defecations increased significantly after naldemedine administration in the overall population, as well as among only those who defecated <3 times/week before naldemedine administration, and those that were administered ≥30 mg/day of morphine equivalent. Diarrhea was the most common adverse event in all grades, occurring in 11 patients (27.5%), of which 9 (81.8%) were grade 1 or 2. None of the patients experienced grade 4 or higher adverse events. Conclusion The efficacy and safety of naldemedine for thoracic cancer patients in clinical practice were comparable with those of prospective studies, which suggest that naldemedine may be effective and feasible for most thoracic cancer patients.
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Affiliation(s)
- Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan.,Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yukiyoshi Fujita
- Division of Pharmacy, Gunma Prefectural Cancer Center, Ota, Japan
| | - Eriko Hiruta
- Division of Pharmacy, Gunma Prefectural Cancer Center, Ota, Japan
| | - Takashi Masuno
- Division of Pharmacy, Fujioka General Hospital, Fujioka, Japan
| | - Shigeki Yamazaki
- Division of Pharmacy, Kiryu Kosei General Hospital, Kiryu, Japan
| | - Hajime Tanaka
- Division of Pharmacy, Haramachi Red Cross Hospital, Higashiagatsuma-machi, Agatsuma-gun, Japan
| | - Teruhiko Kamiya
- Department of Pharmacy, Tatebayashi Kosei General Hospital, Tatebayashi, Japan
| | | | - Satoshi Takei
- Division of Pharmacy, Tone Central Hospital, Numata, Japan
| | - Kazuya Arai
- Division of Pharmacy, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Hiromi Nishiba
- Division of Pharmacy, Japan Community Health Care Organization (JCHO) Gunma Chuo Hospital, Maebashi, Japan.,Graduate School of Pharmaceutical Sciences, Takasaki University of Health and Welfare, Takasaki, Japan
| | | | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
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