Lubiprostone provides significant relief from opioid-induced constipation (OIC) in patients prescribed these medications for chronic non-cancer pain, according to a study published in Pain Medicine.
This pooled analysis of 3 randomized placebo-controlled phase 3 studies indicated that lubiprostone led to a significant increase in bowel movement frequency in patients with OIC due to phenanthrene opioids (n=1159; P =.0001). Lubiprostone also led to improvements in overall OIC symptoms and to a greater response rate compared with placebo (P ≤.0229 and P =.0024, respectively).
The investigators also observed an improvement in the frequency of bowel movements in patients with chronic non-cancer pain taking phenylpiperidine opioids with lubiprostone treatment (P =.0129). Compared with placebo, these patients also experienced a trend toward a favorable response (21.4% vs 9.8%; P =.0723).
In patients taking morphine or codeine, no significant changes in bowel movement frequency were observed in either the lubiprostone or placebo group. In addition, no differences were observed in either the lubiprostone or placebo group in patients receiving diphenylheptanes.
Few adverse events were observed in patients receiving lubiprostone. Nausea (13.4% to 18.1%) and diarrhea (1.2% to 13.9%) were the most common treatment-emergent adverse events in all 3 studies. According to the investigators, study participants had a greater chance of experiencing adverse events 1 week after treatment, with the chances decreasing thereafter.
Sample sizes in some of the groups receiving specific opioid classes (eg, phenylpiperidine, hydromorphone, and oxymorphone) were small, potentially reducing the ability to provide conclusive insight into the effect of lubiprostone in patients experiencing OIC.
The study investigators suggested that “some activity of lubiprostone may be retained with lower doses of diphenylheptanes, although formal demonstration of the effects is lacking.”
Webster LR, Brewer RP, Lichtlen P, et al. Efficacy of lubiprostone for the treatment of opioid-induced constipation, analyzed by opioid class. Pain Medicine [published online October 9, 2017]. doi:10.1093/pm/pnx212