Optimal treatment of opioid induced constipation in daily clinical practice - an observational study

Elisabeth C W Neefjes, Hanneke van der Wijngaart, Maurice J D L van der Vorst, Diederik Ten Oever, Hans J van der Vliet, Aart Beeker, Christiaan A Rhodius, Hendrik P van den Berg, Johannes Berkhof, Henk M W Verheul, Elisabeth C W Neefjes, Hanneke van der Wijngaart, Maurice J D L van der Vorst, Diederik Ten Oever, Hans J van der Vliet, Aart Beeker, Christiaan A Rhodius, Hendrik P van den Berg, Johannes Berkhof, Henk M W Verheul

Abstract

Background: Opioids are prescribed in over 40% of patients with advanced cancer, but side effects occur frequently. In this study we evaluated the development and treatment of opioid induced constipation (OIC), and OIC resolving effect of methylnaltrexone for different opioid subtypes in daily clinical practice.

Methods: Patients with cancer using opioids were included in a retrospective chart analysis. Baseline characteristics, data on opioid use, laxative use, and OIC were collected. Patients with OIC who were prescribed methylnaltrexone, were included in a prospective observational trial (NCT01955213).

Results: Thirty-nine of 327 patients (pts) with cancer who were treated with opioids suffered from OIC (overall prevalence 12%; 95%-CI: 8-15%). The prevalence of OIC was similar in patients treated with oxycodone or fentanyl (12 of 81 pts. vs. 18 of 110 pts., RR 0.9; 95%CI 0.4-2.0). The morphine equivalent daily dose did not significantly differ between opioid subtypes (fentanyl 89 mg (IQR 60-180) vs. oxycodone 40 mg (40-80), P = 0.231). Twenty-two individual patients (7%) were admitted for OIC. Most effective laxatives in admitted patients were enemas, methylnaltrexone, or 4-l polyethylene-glycol solution. In the prospective observational study, the effect of methylnaltrexone could be evaluated in 23 patients. Eleven patients achieved the primary endpoint of ≥2 laxation responses out of the first four doses methylnaltrexone, independent of opioid subtype.

Conclusions: OIC is a burdensome clinical problem independent of opioid subtype. Timely intensification of prophylactic laxative treatment, especially when opioid doses increase, may help to prevent OIC. Clinically overt OIC requires a more intensive laxative regimen with for example methylnaltrexone.

Trial registration: NCT01955213 .

Keywords: Constipation; Laxatives; Methylnaltrexone; Neoplasms; Opioid; Pain management.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Medical research Ethics Committee of the VU University medical center and performed in accordance with the Helsinki Declaration of the World Medical Association. All patients provided written informed consent before participating in this study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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