Methylnaltrexone for Refractory Opioid-Induced Constipation in Hospitalized Cancer Patients—A Highly Effective Treatment (F415A)

• Published in: Journal of pain and symptom management 2021-03, Vol.61 (3), p.650-650
• Main Authors: Harris, David, Kalir, David Z., Chevalier, Cory A., Dobbie, Krista R., Fielding, Flannery, Lee, Ruth L., Makhoul, Ahed, McInnes, Susan, Neale, Kyle, Rybicki, Lisa, Robbins-Ong, Melanie, Neuendorf, Kathleen, Najafi, Sina
• Format: Article
• Language: English
• Subjects: Cancer; Chart reviews; Clinical trials; Constipation; Dosage; Efficacy; Hospitalization; Hospitalized; Hostility; Induced; Inpatient care; Laxatives; Medical diagnosis; Morphine; Narcotics; Opioids; Pain; Palliative care; Response rates; Teams
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2021.01.030

Objectives 1. Describe the overall efficacy of methylnaltrexone when prescribed to hospitalized cancer patients for opioid-induced constipation. 2. Recognize the difference in response rates between patients receiving lower doses of opioids and those receiving higher doses of opioids. Original Research Background Methylnaltrexone is a peripherally acting mu-opioid receptor antagonist that has been studied in cancer and non-cancer patients with opioid-induced constipation (OIC), but only in the outpatient setting. For hospitalized patients with cancer pain and laxative-refractory OIC, its effectiveness is unknown. Research Objectives Describe the efficacy of methylnaltrexone on OIC in the inpatient setting. Methods We performed a single-center, retrospective chart review of all hospitalized, adult patients with a cancer diagnosis who received methylnaltrexone from the palliative medicine team at our institution between January 1, 2012, and July 1, 2019. Results We identified 365 patients. The mean age was 57, 54% were male, and 82% were white. 360 patients (99%) received the 6 mg dose. The median oral morphine equivalent (OME) was 144 mg (range 0-4320mg). 58% (95% CI, 53-63%) had a bowel movement (BM) within 24 hours, and 73% (95% CI, 69-78%) had a BM within 48 hours. Higher OME was associated with successful BM. Patients with 150 OME had a response rate of 95% (p 150 OME. Implications for Research, Policy, or Practice Randomized controlled trials have shown that in the outpatient setting about 50% of patients respond to methylnaltrexone as a maintenance therapy for OIC. Here we describe a higher response rate of up to 95% in patients taking >150 OME. Methylnaltrexone is a highly effective treatment for refractory OIC in the inpatient setting.