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阿片类药物所致胃肠道症状治疗的新进展。

New developments in the treatment of opioid-induced gastrointestinal symptoms.

作者信息

Pannemans Jasper, Vanuytsel Tim, Tack Jan

机构信息

Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases, Metabolism and Ageing, KU Leuven University, Leuven, Belgium.

出版信息

United European Gastroenterol J. 2018 Oct;6(8):1126-1135. doi: 10.1177/2050640618796748. Epub 2018 Aug 27.

DOI:10.1177/2050640618796748
PMID:30288274
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6169055/
Abstract

Chronic pain affects a large part of the global population, leading to an increase of opioid use. Opioid-induced constipation (OIC), a highly prevalent adverse effect of opioid use, has a major impact on patients' quality of life. Thanks to the introduction of new drugs for chronic constipation, which can also be used in OIC, and the development of peripherally acting mu-opioid receptor blockers, specifically for use in OIC, therapeutic options have seen major development. This review summarises current and emerging treatment options for OIC based on an extensive bibliographical search. Efficacy data for laxatives, lubiprostone, prucalopride, linaclotide, oxycodone/naloxone combinations, methylnaltrexone, alvimopan, naloxegol, naldemedine, axelopran, and bevenopran in OIC are summarised.

摘要

慢性疼痛影响着全球很大一部分人口,导致阿片类药物使用量增加。阿片类药物引起的便秘(OIC)是阿片类药物使用中一种非常普遍的不良反应,对患者的生活质量有重大影响。由于可用于慢性便秘且也可用于OIC的新药的推出,以及专门用于OIC的外周作用μ-阿片受体阻滞剂的开发,治疗选择有了重大进展。本综述基于广泛的文献检索总结了OIC目前和新出现的治疗选择。总结了泻药、鲁比前列酮、普芦卡必利、利那洛肽、羟考酮/纳洛酮组合、甲基纳曲酮、阿洛司琼、纳洛戈、纳地美定、阿克洛普仑和贝韦普仑在OIC中的疗效数据。

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本文引用的文献

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Long-term use of naldemedine in the treatment of opioid-induced constipation in patients with chronic noncancer pain: a randomized, double-blind, placebo-controlled phase 3 study.长期使用纳洛美丁治疗慢性非癌痛患者阿片类药物引起的便秘:一项随机、双盲、安慰剂对照的 3 期研究。
Pain. 2018 May;159(5):987-994. doi: 10.1097/j.pain.0000000000001174.
2
Efficacy and Safety of Lubiprostone in Patients with Opioid-Induced Constipation: Phase 3 Study Results and Pooled Analysis of the Effect of Concomitant Methadone Use on Clinical Outcomes.鲁比前列酮治疗阿片类药物诱导性便秘的疗效和安全性:3 期研究结果及合并使用美沙酮对临床结局影响的汇总分析。
Pain Med. 2018 Jun 1;19(6):1184-1194. doi: 10.1093/pm/pnx156.
3
Naldemedine versus placebo for opioid-induced constipation (COMPOSE-1 and COMPOSE-2): two multicentre, phase 3, double-blind, randomised, parallel-group trials.纳洛美丁与安慰剂治疗阿片类药物引起的便秘(COMPOSE-1 和 COMPOSE-2):两项多中心、3 期、双盲、随机、平行组试验。
Lancet Gastroenterol Hepatol. 2017 Aug;2(8):555-564. doi: 10.1016/S2468-1253(17)30105-X. Epub 2017 May 30.
4
Management of chronic pain using complementary and integrative medicine.采用补充和整合医学方法管理慢性疼痛。
BMJ. 2017 Apr 24;357:j1284. doi: 10.1136/bmj.j1284.
5
Opioid-Induced Constipation and Bowel Dysfunction: A Clinical Guideline.阿片类药物引起的便秘和肠道功能障碍:临床指南。
Pain Med. 2017 Oct 1;18(10):1837-1863. doi: 10.1093/pm/pnw255.
6
Randomized, Double-Blind Trial of Oral Methylnaltrexone for the Treatment of Opioid-Induced Constipation in Patients with Chronic Noncancer Pain.随机、双盲临床试验:口服美沙酮治疗慢性非癌痛患者阿片类药物诱导性便秘
Pain Pract. 2017 Jul;17(6):820-828. doi: 10.1111/papr.12535. Epub 2017 Feb 10.
7
Bowel Disorders.肠道疾病
Gastroenterology. 2016 Feb 18. doi: 10.1053/j.gastro.2016.02.031.
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Efficacy and safety of naloxegol in patients with opioid-induced constipation and laxative-inadequate response.纳洛酮在阿片类药物诱导的便秘和泻药反应不足的患者中的疗效和安全性。
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A randomized, placebo-controlled trial of lubiprostone for opioid-induced constipation in chronic noncancer pain.鲁比前列酮治疗慢性非癌性疼痛中阿片类药物所致便秘的随机、安慰剂对照试验。
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