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

Research output: Contribution to journalArticleAcademicpeer-review

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.
Original languageEnglish
Article number31
JournalBMC Palliative Care
Volume18
Issue number1
DOIs
Publication statusPublished - 2019

Cite this

@article{0e1056ea45b04e60b9513d806bc04a4b,
title = "Optimal treatment of opioid induced constipation in daily clinical practice - An observational study",
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.",
author = "Neefjes, {Elisabeth C. W.} and {van der Wijngaart}, Hanneke and {van der Vorst}, {Maurice J. D. L.} and {ten Oever}, Diederik and {van der Vliet}, {Hans J.} and Aart Beeker and Rhodius, {Christiaan A.} and {van den Berg}, {Hendrik P.} and Johannes Berkhof and Verheul, {Henk M. W.}",
year = "2019",
doi = "10.1186/s12904-019-0416-7",
language = "English",
volume = "18",
journal = "BMC Palliative Care",
issn = "1472-684X",
publisher = "BioMed Central",
number = "1",

}

Optimal treatment of opioid induced constipation in daily clinical practice - An observational study. / Neefjes, Elisabeth C. W.; van der Wijngaart, Hanneke; van der Vorst, Maurice J. D. L.; ten Oever, Diederik; van der Vliet, Hans J.; Beeker, Aart; Rhodius, Christiaan A.; van den Berg, Hendrik P.; Berkhof, Johannes; Verheul, Henk M. W.

In: BMC Palliative Care, Vol. 18, No. 1, 31, 2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Optimal treatment of opioid induced constipation in daily clinical practice - An observational study

AU - Neefjes, Elisabeth C. W.

AU - van der Wijngaart, Hanneke

AU - van der Vorst, Maurice J. D. L.

AU - ten Oever, Diederik

AU - van der Vliet, Hans J.

AU - Beeker, Aart

AU - Rhodius, Christiaan A.

AU - van den Berg, Hendrik P.

AU - Berkhof, Johannes

AU - Verheul, Henk M. W.

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/30922276

U2 - 10.1186/s12904-019-0416-7

DO - 10.1186/s12904-019-0416-7

M3 - Article

VL - 18

JO - BMC Palliative Care

JF - BMC Palliative Care

SN - 1472-684X

IS - 1

M1 - 31

ER -