Efficacy and safety of naloxegol in patients with opioid‐induced constipation and laxative‐inadequate response

Tack, Jan; Lappalainen, Jaakko; Diva, Ulysses; Tummala, Raj; Sostek, Mark

doi:10.1177/2050640615604543

Cited by 47 publications

(68 citation statements)

References 21 publications

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“…The pooled analysis of LIR patients [Tack et al 2015] confirmed findings from 04 and 05 controlled studies . A greater incidence of AEs was found in naloxegol 25 mg group (63.1%) compared with 12.5 mg group (50.6%) and placebo (50.0%).…”

Section: Adverse Eventssupporting

confidence: 74%

“…A more recent analysis of KODIAC-04 and KODIAC-05 studies demonstrated benefits of naloxegol in patients with inadequate response to conventional laxatives (LIR) [Tack et al 2015]. Patients with LIR were defined as those who, during 2 weeks, had to have reported OIC symptoms of at least moderate severity while taking at least one laxative class for a minimum of 4 days.…”

Section: Overview Of Naloxegol Clinical Studiesmentioning

confidence: 99%

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The role of naloxegol in the management of opioid-induced bowel dysfunction

Leppert

Woroń

2016

Therap Adv Gastroenterol

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Opioid-induced constipation (OIC) and other gastrointestinal (GI) symptoms of opioid-induced bowel dysfunction (OIBD) significantly deteriorate patients’ quality of life and may lead to noncompliance with opioid schedule and undertreatment of pain. Although traditional oral laxatives are the first-line treatment of OIC, they do not address OIBD pathophysiology, and display numerous adverse effects. OIC treatment includes prokinetics (lubiprostone), opioid switch, and changing route of opioid administration. Targeted management of OIBD comprises the use of purely peripherally acting μ-opioid receptor antagonists (PAMORA): naloxegol and methylnaltrexone. Naloxegol (NKTR-118) is a polymer conjugate of the opioid antagonist naloxone. The polyethylene glycol limits naloxegol capacity to cross the blood–brain barrier (BBB). Naloxegol is substrate for the P-glycoprotein (P-gp) transporter. The central nervous system penetration of naloxegol is negligible due to reduced permeability and its increased efflux across the BBB, related to P-gp transporter. Naloxegol antagonizes μ- and κ-opioid receptors and displays low affinity to δ-opioid receptors in the GI tract, thereby decreasing OIBD symptoms without reversing central analgesic effects. Naloxegol is metabolised through CYP3A4 to six metabolites, with the majority of the dose (68%) excreted with faeces and less (16%) with urine. The dose of naloxegol equals 25 mg administered orally once daily on a fasting condition. Mild or moderate hepatic impairment has no impact on naloxegol dosing; naloxegol was not studied and is not recommended in patients with hepatic failure. Dose reduction (12.5 mg once daily) and caution is recommended in patients with moderate-to-severe renal impairment. Efficacy (bowel movement in 42–49% of patients not responsive to laxatives) and safety of naloxegol were confirmed in studies conducted in patients with OIC and nonmalignant pain. Naloxegol may be useful for cancer patients with OIC, although studies in this population are lacking.

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Section: Adverse Eventssupporting

confidence: 74%

Section: Overview Of Naloxegol Clinical Studiesmentioning

confidence: 99%

The role of naloxegol in the management of opioid-induced bowel dysfunction

Leppert

Woroń

2016

Therap Adv Gastroenterol

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“…In phase III studies, both substances have been shown to be highly effective and tolerable [30][31][32]; both drugs may be combined with all available opioid regimes irrespective of the choices of substance, medication routes, or dosing.…”

Section: Secretagoguesmentioning

confidence: 99%

Medical Therapy of Constipation: Current Standards and Beyond

Andresen

Layer²

2018

Visc Med

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Chronic constipation is a very common medical problem with relevant impact on the patients' quality of life. Modern definitions recognize constipation as a polysymptomatic disorder, including various aspects of disturbed defecation. Current guidelines recommend a stepwise approach in the management of chronic constipation. Isolated or concomitant evacuation disorders should be identified and may need differential/additional treatment. Baseline measures include lifestyle components and bulking agents. The next step recommends treatment with conventional laxatives. In refractory patients, modern medical therapies, such as the prokinetic prucalopride or the secretagogues linalotide or lubiprostone, may be used effectively. For patients with opioid-induced constipation, the modern concept of peripherally acting µ-opioid antagonists has shown to successfully improve this increasing medical problem and even to potentially increase survival time in terminally ill patients on opioid therapy. Prolonged-released oral naloxone (in fixed combination with oxycodone), oral naloxegol or naldemedine, and subcutaneous methylnaltrexone have all demonstrated good efficacy and tolerability in the treatment of opioid-induced constipation. To adequately apply stepwise treatment algorithms, a simple tool to identify treatment failure may improve patient care.

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“…Der erste oral verfügbare Vertreter der PAMO-RA ist Naloxegol, ein pegyliertes Derivat des μ-Opioid-Rezeptor-Antagonisten Naloxon [6]. Die Wirksamkeit und Sicherheit der Behandlung mit Naloxegol wurde in den randomisierten placebokontrollierten Phase-III-Studien KODIAC 4 und KODIAC 5 evaluiert [16,17]. «Naloxegol kann in Bezug auf das eingesetzte Opioid viel einfacher und unkomplizierter angewendet werden als das unspezifische Naloxon», sagte Dr. Wirz im Interview.…”

Section: Pharmanewsunclassified

PharmaNews

2017

Visc Med

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Efficacy and safety of naloxegol in patients with opioid‐induced constipation and laxative‐inadequate response

Abstract: Naloxegol was efficacious, generally safe and well tolerated in the patients with OIC and LIR, while preserving opioid analgesia. ClinicalTrials.gov identifiers: NCT01309841; NCT01323790.

Cited by 47 publications

References 21 publications

The role of naloxegol in the management of opioid-induced bowel dysfunction

The role of naloxegol in the management of opioid-induced bowel dysfunction

Medical Therapy of Constipation: Current Standards and Beyond

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