Factors for Discontinuation of Naldemedine Therapy in a Palliative Ward

Opioid-induced constipation (OIC) is a common adverse drug event in patients undergoing chronic pain therapy. Naldemedine is an oral, peripherally acting μ-opioid receptor antagonist that improves bowel movement without affecting opioid pain relief. In palliative wards, many patients experience malnutrition caused by cachexia and systemic inflammation because of cancer progression. We investigated whether the C-reactive protein-to-albumin ratio (CAR) affects the continuation of naldemedine therapy in a palliative ward.

We included Japanese patients in the palliative ward of Fujita Health University Hospital between April 2020 and August 2023 in this retrospective observational study. The log-rank test was used to compare the continuation rates of naldemedine over 14 days. Cox proportional hazards analysis was performed using the terms morphine-equivalent daily dose <30 mg and CAR ≥0.888.

Eighty patients were divided into continuation (n=58) and discontinuation (n=22) groups. The proportion of patients with a CAR ≥0.888 was significantly higher in the discontinuation group than in the continuation group (p =0.020). Cox proportional hazards analysis showed that morphine-equivalent daily dose <30 mg was not a factor for discontinuation of naldemedine therapy (hazard ratio=1.040, p=0.929) but CAR ≥0.888 was (hazard ratio=3.251, p=0.035).

A high CAR (≥0.888) was a risk factor for the discontinuation of naldemedine therapy in a palliative ward. Our results suggest that physicians and pharmacists should monitor CAR as a marker of malnutrition and systemic inflammation before initiating naldemedine therapy.