Liu Katie, Chen Ariana, Rajaram Pranav, Buning Grayson, Lee Allen A, Singh Prashant
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Clin Transl Gastroenterol. 2025 Jun 13;16(8):e00876. doi: 10.14309/ctg.0000000000000876. eCollection 2025 Aug 1.
Peripherally acting u-opioid receptor antagonists (PAMORAs) are a safe and efficacious medication for treating opioid-induced constipation (OIC). This study evaluates the utilization of PAMORAs in patients with laxative-refractory OIC.
Patients diagnosed with OIC from 2018 to 2023 were retrospectively identified at a tertiary care center. As recommended by the guidelines, patients were considered eligible for PAMORAs if they had failed at least 2 laxatives. Data on PAMORA prescription, demographics, clinical characteristics, and specialty of the managing provider were collected and analyzed using logistic regression and χ 2 analysis.
Of 281 patients diagnosed with OIC, 204 (73%) were eligible for a PAMORA, of which only 58 (28%) were prescribed one. There were no differences in demographic or clinical characteristics between those who were offered PAMORAs vs not. There was a significant difference in prescribing patterns based on provider specialty ( P < 0.001). Although gastrointestinal (GI) specialists saw less than half of the eligible patients, they offered PAMORAs at the highest proportion of 59% compared with non-GI specialists (13-16%) or primary care providers (18%). Multivariable logistic regression analysis showed 12.7-fold increased odds of being offered a PAMORA if the provider was from the GI department compared with all non-GI providers ( P < 0.001).
PAMORAs are underutilized in patients with OIC. GI prescribers offer PAMORAs at a higher proportion than other departments, and being seen in GI independently increases the likelihood of a patient receiving a PAMORA. This suggests that underutilization may be due to a lack of awareness and further education about PAMORAs is warranted.
外周作用的μ-阿片受体拮抗剂（PAMORAs）是治疗阿片类药物引起的便秘（OIC）的一种安全有效的药物。本研究评估PAMORAs在泻药难治性OIC患者中的使用情况。
在一家三级医疗中心对2018年至2023年诊断为OIC的患者进行回顾性识别。根据指南建议，如果患者至少使用过2种泻药治疗失败，则被认为有资格使用PAMORAs。收集有关PAMORA处方、人口统计学、临床特征以及管理医生专业的数据，并使用逻辑回归和χ²分析进行分析。
在281例诊断为OIC的患者中，204例（73%）有资格使用PAMORAs，其中只有58例（28%）被开具了该药物。接受PAMORAs治疗的患者与未接受治疗的患者在人口统计学或临床特征方面没有差异。基于医生专业的处方模式存在显著差异（P<0.001）。尽管胃肠（GI）专科医生诊治的符合条件患者不到一半，但他们开具PAMORAs的比例最高，为59%，而非GI专科医生（13 - 16%）或初级保健医生（18%）。多变量逻辑回归分析显示，与所有非GI科室医生相比，如果医生来自GI科室，患者接受PAMORAs治疗的几率增加12.7倍（P<0.001）。
PAMORAs在OIC患者中未得到充分利用。GI科室的开处方者开具PAMORAs的比例高于其他科室，且在GI科室就诊会独立增加患者接受PAMORAs治疗的可能性。这表明未充分利用可能是由于缺乏认识，有必要进一步开展关于PAMORAs的教育。
