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Brenner DM, Argoff CE, Fox SM, Bochenek W, D'Astoli P, Blakesley RE, Reasner DS, O'Dea CR, Cash BD. Efficacy and safety of linaclotide for opioid-induced constipation in patients with chronic noncancer pain syndromes from a phase 2 randomized study. Pain 2020; 161:1027-1036. [PMID: 32310620 PMCID: PMC7170446 DOI: 10.1097/j.pain.0000000000001754] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/31/2019] [Accepted: 11/12/2019] [Indexed: 12/19/2022]
Abstract
Constipation is the most common adverse event (AE) of opioid therapy. This multicenter, phase 2 study evaluated the efficacy and safety of linaclotide in treating opioid-induced constipation (OIC) in patients with chronic noncancer pain syndromes (NCT02270983). Adults with OIC (<3 spontaneous bowel movements [SBMs]/week) related to chronic noncancer pain were randomized 1:1:1 to receive linaclotide 145 µg, linaclotide 290 µg, or placebo once daily for 8 weeks. The primary endpoint was change from baseline in 8-week SBM frequency rate (SBMs/week). Secondary efficacy endpoints included 6/8-week SBM 3 + 1 responders, time to first SBM, and changes from baseline in 8-week stool consistency, abdominal bloating, and straining. Additional endpoints included treatment satisfaction and adequate relief responders. In total, 254 patients were randomized: 87, 88, and 79 received linaclotide 145 µg, linaclotide 290 µg, and placebo, respectively. The mean changes from baseline in SBMs/week during the treatment period were 2.9 and 3.5 in the linaclotide 145 and 290 µg groups (P < 0.01 for both doses), respectively, vs 1.6 in the placebo group. Diarrhea, the most common AE, was generally mild, resulting in 1.1%, 5.7%, and 1.3% of patients discontinuing in the linaclotide 145 μg, linaclotide 290 μg, and placebo groups, respectively. No serious AEs related to diarrhea were reported in any treatment group. Compared with placebo, linaclotide-treated patients had significant improvements in stool consistency, straining, abdominal bloating, and treatment satisfaction scores (P < 0.05). Linaclotide significantly improved OIC symptoms and was well tolerated in patients with chronic noncancer pain.
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Affiliation(s)
- Darren M. Brenner
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Charles E. Argoff
- Comprehensive Pain Center, Albany Medical College, Albany, NY, United States
| | - Susan M. Fox
- Clinical Development Department, Allergan plc, Madison, NJ, United States
| | - Wieslaw Bochenek
- Clinical Development Department, Allergan plc, Madison, NJ, United States
| | - Patricia D'Astoli
- Clinical Development Department, Allergan plc, Madison, NJ, United States
| | - Rick E. Blakesley
- Biostatistics Department, Allergan plc, Madison, NJ, United States. Dr. Blakesley is now with Biostatistics, Alnylam Pharmaceuticals, Cambridge, MA, United States
| | - David S. Reasner
- Data Science Department, Ironwood Pharmaceuticals, Inc, Cambridge, MA, United States. Dr. Reasner is now with Data Science and Analytics, Imbria Pharmaceuticals, Boston, MA, United States
| | - Christopher R. O'Dea
- Clinical Development Department, Ironwood Pharmaceuticals, Inc, Cambridge, MA, United States
| | - Brooks D. Cash
- Ertan Digestive Disease Center, University of Texas Health Science Center, Houston, TX, United States
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