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Novel opioid antagonists for opioid-induced bowel dysfunction
Laura Diego1, Rabia Atayee, Pieter Helmons
1Institute for Palliative Medicine at San Diego Hospice, CA, USA.
Expert Opinion on Investigational Drugs
|June 14, 2011
Summary
Opioid-induced bowel dysfunction (OBD) is a common side effect. Novel peripherally acting mu-opioid receptor antagonists (PAMORA) offer targeted relief for OBD without impacting pain management.
Area of Science:
- Gastroenterology
- Pharmacology
- Pain Management
Background:
- Opioid analgesics cause frequent, burdensome gastrointestinal adverse effects, impacting patient quality of life.
- Opioid-induced bowel dysfunction (OBD) affects up to 81% of patients, even with laxative use.
- Targeting gut receptors with opioid antagonists offers new treatment avenues for opioid-induced gastrointestinal adverse effects.
Purpose of the Study:
- Review the pathophysiology, prevalence, and burden of opioid-induced bowel dysfunction (OBD).
- Clarify the mechanism of action of novel opioid antagonists for OBD.
- Evaluate the efficacy, safety, and latest research on these agents.
Main Methods:
- Literature review of pathophysiology, prevalence, and burden of OBD.
- Analysis of mechanism of action for opioid antagonists.
- Review of clinical trial data on efficacy and safety of novel agents.
Main Results:
- Peripherally acting mu-opioid receptor antagonists (PAMORA) effectively treat OBD without central analgesia interference.
- Marketed PAMORA (methylnaltrexone, alvimopan) offer a mechanism-based approach.
- New oral PAMORA are in clinical development, expanding treatment options.
Conclusions:
- PAMORA represent a significant advancement in managing opioid-induced gastrointestinal dysfunction.
- Current PAMORA use is limited by response rates and cost.
- Ongoing development of novel oral PAMORA promises improved OBD management paradigms.
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