Methylnaltrexone for Opioid-induced Constipation in Cancer Patients - Full Text View

Purpose

The purpose of this study is to evaluate the efficacy of methylnaltrexone in relieving opioid-induced constipation in cancer patients at various stages of disease.

Condition	Intervention	Phase
Neoplasms Constipation Opioid-Related Disorders	Drug: Methylnaltrexone bromide	Phase 2


Study Type:	Interventional
Study Design:	Intervention Model: Single Group Assignment Masking: None (Open Label) Primary Purpose: Supportive Care
Official Title:	Phase II Trial of Subcutaneous Methylnaltrexone in the Treatment of Severe Opioid-induced Constipation in Cancer Patients

Resource links provided by NLM:

MedlinePlus related topics: Constipation

Drug Information available for: Methylnaltrexone bromide Methylnaltrexone

U.S. FDA Resources

Further study details as provided by Steven Ades, University of Vermont:

Primary Outcome Measures:

Rescue-free Laxation After Administration of Subcutaneous Methylnaltrexone [ Time Frame: 4 hours after the dose of subcutaneous methylnaltrexone ]

Secondary Outcome Measures:

Laxation After Administration of Subcutaneous Methylnaltrexone [ Time Frame: 24 and 48 hours after the dose of subcutaneous methylnaltrexone ]
Time to Laxation After Administration of Subcutaneous Methylnaltrexone [ Time Frame: 48 hours after the dose of subcutaneous methylnaltrexone ]
Overall Pain Scores (0-10; 0=no Pain, 10=Worst Pain) After Administration of Subcutaneous Methylnaltrexone [ Time Frame: 48 hours after the dose of subcutaneous methylnaltrexone ]
Symptoms of Opioid Withdrawal (Modified Himmelsbach Withdrawal Scales (Ranging 7-28 in Total; 1=None - 4=Severe for 7 Items)) After Administration of Subcutaneous Methylnaltrexone [ Time Frame: 48 hours after the dose of subcutaneous methylnaltrexone ]
Bowel Movement Assessment (Frequency, Consistency and Difficulty) After Administration of Subcutaneous Methylnaltrexone [ Time Frame: 48 hours after the dose of subcutaneous methylnaltrexone ]
Constipation Assessment (Severity and Distress) After Administration of Subcutaneous Methylnaltrexone [ Time Frame: 48 hours after the dose of subcutaneous methylnaltrexone ]
Patient Satisfaction With the Study Medication After Administration of Subcutaneous Methylnaltrexone [ Time Frame: 48 hours after the dose of subcutaneous methylnaltrexone ]


Enrollment:	12
Study Start Date:	October 2009
Study Completion Date:	December 2013
Primary Completion Date:	December 2013 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Methylnaltrexone bromide A single dose of methylnaltrexone will be administered subcutaneously to eligible subjects based on weight at the study entry. Since we will include subjects at all stages of cancer management, administering this study drug is considered experimental. We will use the dose approved by FDA, i.e., 0.15 mg/kg (round dose up to nearest 0.1 mL of volume) for weight less than 38 kg or greater than 114 kg; 8 mg (0.4 mL) for weight 38 kg to less than 62 kg; and 12 mg (0.6 mL) for weight 62 kg to 114 kg.	Drug: Methylnaltrexone bromide Methylnaltrexone bromide, dosage based on weight (0.15 mg/kg (round dose up to nearest 0.1 mL of volume) for weight less than 38 kg or greater than 114 kg; 8 mg (0.4 mL) for weight 38 kg to less than 62 kg; and 12 mg (0.6 mL) for weight 62 kg to 114 kg), single dose Other Name: Relistor

Arms

Assigned Interventions

Experimental: Methylnaltrexone bromide

A single dose of methylnaltrexone will be administered subcutaneously to eligible subjects based on weight at the study entry. Since we will include subjects at all stages of cancer management, administering this study drug is considered experimental. We will use the dose approved by FDA, i.e., 0.15 mg/kg (round dose up to nearest 0.1 mL of volume) for weight less than 38 kg or greater than 114 kg; 8 mg (0.4 mL) for weight 38 kg to less than 62 kg; and 12 mg (0.6 mL) for weight 62 kg to 114 kg.

Drug: Methylnaltrexone bromide

Methylnaltrexone bromide, dosage based on weight (0.15 mg/kg (round dose up to nearest 0.1 mL of volume) for weight less than 38 kg or greater than 114 kg; 8 mg (0.4 mL) for weight 38 kg to less than 62 kg; and 12 mg (0.6 mL) for weight 62 kg to 114 kg), single dose

Other Name: Relistor

Detailed Description:

Pain is one of the most common and important symptoms of cancer, often requiring opioid analgesics for control. However constipation is one of the most frequent and debilitating side effects of opioids, occurring in 40%-70% of patients being treated for chronic pain. Although laxatives are commonly used to manage opioid-induced constipation, these agents are not always effective or satisfactory. Methylnaltrexone bromide is a peripherally acting antagonist of the mu-opioid receptor. As a quaternary amine, the ability of methylnaltrexone to cross the blood-brain barrier is limited. This allows methylnaltrexone to function as a peripherally-acting antagonist in the gastrointestinal tract without impacting opioid-mediated analgesic effects in the central nervous system. The efficacy and safety of methylnaltrexone in treating opioid-induced constipation in patients with advanced disease receiving palliative care has been demonstrated. However the efficacy of this agent has not been evaluated in more active patients who are earlier in their disease course. The present study will evaluate the efficacy and safety of methylnaltrexone for the relief of severe opioid-induced constipation in this population and will attempt to identify factors predictive of methylnaltrexone response.

Eligibility

Information from the National Library of Medicine

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Ages Eligible for Study:	18 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Histologically or cytologically confirmed neoplasm
18 years of age or older
Have received opioids for analgesia for at least 2 weeks and been on a stable regimen of opioids and laxatives for 3 or more days before study entry
Fewer than three laxation during the preceding week and no laxation within 24 hours before study entry, or no laxation within 48 hours before study entry
Life expectancy of at least 6 months
World Health Organization Performance Status 0-3
Women of childbearing potential must have a negative pregnancy test
Breastfeeding should be discontinued prior to study entry
Ability to understand and the willingness to sign a written informed consent document.
Laboratory values within a week of study entry:

Absolute neutrophil count > 1,500/microliter Hemoglobin > 7 g/dL Platelet count > 100,000/microliter Calculated calcium < 10.5 mg/dL Calculated creatinine clearance > 30 mg.min Alanine aminotransferase < 3 x upper limit of normal (ULN) Aspartate aminotransferase < 3 x ULN Alkaline phosphatase < 2.5 x ULN Bilirubin < 1.5 x ULN

Exclusion Criteria:

Constipation not primarily caused by opioids, such as mechanical gastrointestinal obstruction or ongoing vinca alkaloid administration
Indwelling peritoneal catheter
Clinically active diverticular disease
Fecal impaction
Acute surgical abdomen
Fecal ostomy
Peritoneal carcinomatosis
Known hypersensitivity to methylnaltrexone, naltrexone, or naloxone
Administration of any investigational drug or experimental product within the previous 30 days
Initiation of a new bowel regimen or prokinetic agents within a week of study entry

Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01004393

Locations


United States, Vermont
Fletcher Allen Health Care
Burlington, Vermont, United States, 05401

Sponsors and Collaborators

University of Vermont

Investigators


Principal Investigator:	Steven Ades, MD	Fletcher Allen Health Care / University of Vermont College of Medicine

More Information


Responsible Party:	Steven Ades, Associate Professor, University of Vermont
ClinicalTrials.gov Identifier:	NCT01004393 History of Changes
Other Study ID Numbers:	VCC 0911 VCC 0911 ( Other Identifier: Vermont Cancer Center )
First Submitted:	October 28, 2009
First Posted:	October 29, 2009
Results First Submitted:	June 14, 2015
Results First Posted:	February 2, 2016
Last Update Posted:	February 2, 2016
Last Verified:	December 2015

Keywords provided by Steven Ades, University of Vermont:


Methylnaltrexone Constipation Narcotic Antagonists Analgesics, Opioid Neoplasms

Additional relevant MeSH terms:


Constipation Opioid-Related Disorders Signs and Symptoms, Digestive Signs and Symptoms Substance-Related Disorders Chemically-Induced Disorders Mental Disorders Analgesics, Opioid Bromides Methylnaltrexone	Naltrexone Narcotics Central Nervous System Depressants Physiological Effects of Drugs Analgesics Sensory System Agents Peripheral Nervous System Agents Anticonvulsants Narcotic Antagonists