Bart J Morlion1, Stefan A Mueller-Lissner2, Renato Vellucci3, Wojciech Leppert4,5, Benoît C Coffin6,7, Sara L Dickerson8, Tony O'Brien9,10. 1. Leuven Centre for Algology and Pain Management, Anaesthesiology and Algology, Department of Cardiovascular Sciences, University Hospitals Leuven, University of Leuven, Leuven, Belgium. 2. Independent Researcher, Berlin, Germany. 3. Palliative Care and Pain Therapy Unit, University Hospital, Careggi, Florence, Italy. 4. Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland. 5. Department of Quality of Life Research, Medical University of Gdansk, Gdansk, Poland. 6. Department of Gastroenterology, Louis Mourier Hospital, Assistance Publique - Hôpitaux de Paris, Colombes, France. 7. University Denis Diderot-Paris VII, Paris, France. 8. Mundipharma International Ltd, Cambridge Science Park, Cambridge, U.K. 9. Marymount University Hospital and Hospice, Cork, Ireland. 10. Cork University Hospital and College of Medicine and Health, University College Cork, Cork, Ireland.
Abstract
BACKGROUND: Opioids provide effective relief from moderate-to-severe pain and should be prescribed as part of a multifaceted approach to pain management when other treatments have failed. Fixed-dose oxycodone/naloxone prolonged-release tablets (OXN PR) were designed to address the opioid class effect of opioid-induced constipation (OIC) by combining the analgesic efficacy of oxycodone with the opioid receptor antagonist, naloxone, which has negligible systemic availability when administered orally. This formulation has abuse-deterrent properties, since systemic exposure to naloxone by parenteral administration would antagonize the euphoric effects of oxycodone. METHODS: A literature search was conducted to assess the evidence base for OXN PR to treat moderate-to-severe pain and its impact on bowel function, based on published clinical trials and observational studies. RESULTS: Extensive data demonstrate that OXN PR provides effective analgesia and clinically relevant improvements in bowel function in patients with OIC and moderate-to-severe cancer-related pain and noncancer pain types such as low back pain, neuropathic pain, and musculoskeletal pain. OXN PR has also been found to improve bowel function in patients with OIC refractory to multiple types of laxatives, and improve Parkinson's disease-related pain. No unanticipated safety concerns have been reported in elderly patients. CONCLUSIONS: Evidence from clinical trials and observational studies confirms that for selected patients OXN PR significantly improves moderate-to-severe chronic pain and provides relief from OIC. Treatment should be tailored to individual patients to establish the lowest effective dose. An absence of analgesic ceiling effect was seen across the clinically relevant dose range investigated (≤ 160/80 mg/day).
BACKGROUND: Opioids provide effective relief from moderate-to-severe pain and should be prescribed as part of a multifaceted approach to pain management when other treatments have failed. Fixed-dose oxycodone/naloxone prolonged-release tablets (OXN PR) were designed to address the opioid class effect of opioid-induced constipation (OIC) by combining the analgesic efficacy of oxycodone with the opioid receptor antagonist, naloxone, which has negligible systemic availability when administered orally. This formulation has abuse-deterrent properties, since systemic exposure to naloxone by parenteral administration would antagonize the euphoric effects of oxycodone. METHODS: A literature search was conducted to assess the evidence base for OXN PR to treat moderate-to-severe pain and its impact on bowel function, based on published clinical trials and observational studies. RESULTS: Extensive data demonstrate that OXN PR provides effective analgesia and clinically relevant improvements in bowel function in patients with OIC and moderate-to-severe cancer-related pain and noncancer pain types such as low back pain, neuropathic pain, and musculoskeletal pain. OXN PR has also been found to improve bowel function in patients with OIC refractory to multiple types of laxatives, and improve Parkinson's disease-related pain. No unanticipated safety concerns have been reported in elderly patients. CONCLUSIONS: Evidence from clinical trials and observational studies confirms that for selected patientsOXN PR significantly improves moderate-to-severe chronic pain and provides relief from OIC. Treatment should be tailored to individual patients to establish the lowest effective dose. An absence of analgesic ceiling effect was seen across the clinically relevant dose range investigated (≤ 160/80 mg/day).
Authors: Peter S Ostling; Kelly S Davidson; Best O Anyama; Erik M Helander; Melville Q Wyche; Alan D Kaye Journal: Curr Pain Headache Rep Date: 2018-04-04