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Management of Opioid-induced Constipation With Darren Brenner, MD
Darren M. Brenner, MD
Release Date: December 22, 2014
Expiration Date: December 21, 2015 (THIS ACTIVITY IS NO LONGER AVAILABLE FOR CREDIT)
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Program Overview
Can you ID OIC? Find solutions to detect, diagnose, and manage opioid-induced constipation (OIC) sooner in your patients with chronic, non-cancer pain.This CME case-based activity features:
• A review of available therapies for OIC
• Strategies to individualize management plans for OIC
LEARNING OBJECTIVES
Upon completion of this educational activity, participants should be able to:
• Summarize the efficacy data, associated advantages and disadvantages, and onset and mechanism of action for management options available for OIC
• Identify management strategies for patients with OIC, based on their symptoms and preferences and onset and mechanism of action for therapeutic agents
FACULTY
Darren M. Brenner, MD
Assistant Professor in Medicine–Gastroenterology and Hepatology and Surgery
Northwestern University Feinberg School of Medicine, Chicago, IL
FACULTY BIOGRAPHY
Darren M. Brenner, MD
Darren M. Brenner, MD, is an Assistant Professor in Medicine–Gastroenterology and Hepatology and Surgery at the Northwestern University Feinberg School of Medicine in Chicago, Illinois. He received his medical degree from the University of Chicago Pritzker School of Medicine and completed his residency in internal medicine and fellowship in gastroenterology at the University of Michigan Hospitals in Ann Arbor, where he served as chief fellow.
Dr Brenner’s clinical and research pursuits focus on lower gastrointestinal motility disorders. He is actively engaged in scleroderma research and multiple clinical trials assessing the use of alternative and dietary therapies in the treatment of irritable bowel syndrome. Dr Brenner has received multiple teaching awards from the Departments of Medicine and Surgery at Northwestern University Feinberg School of Medicine and has been invited to be a charter board member of the American Gastroenterological Association Academy of GI and Liver Educators. He has lectured on both local and national levels and published peer-reviewed articles on functional gastrointestinal disorders. Dr Brenner currently serves as a reviewer and on the editorial boards of several prominent gastrointestinal journals, including Gastroenterology, the American Journal of Gastroenterology, and the British Medical Journal.
DISCLOSURES STATEMENTS
In accordance with the Accreditation Council for Continuing Medical Education (ACCME), Dannemiller requires that any person who is in a position to control the content of a CME activity must disclose all relevant financial relationships they have with a commercial interest.
Darren M. Brenner, MD
Speakers Bureau: Ironwood Pharmaceuticals, Inc/Forest Laboratories, Inc; Salix Pharmaceuticals, Inc
Consultant/Advisory Board: Perrigo Company; Salix Pharmaceuticals, Inc
In order to resolve conflict of interest, presentations of this activity were peer reviewed by an independent reviewer. The reviewer has no relationship with a commercial interest. The resulting certified activity was found to provide educational content that is current, evidence based, and commercially balanced.
Independent Reviewer
Bernard M. Abrams, MD
Medical Director
Dannemiller
San Antonio, TX
Clinical Professor of Neurology
University of Missouri School of Medicine at Kansas City
Kansas City, MO
Nothing to disclose with regard to commercial support
Educational Planning Committee
Dannemiller
Gordon Ringler
Nothing to disclose with regard to commercial support
Spire Learning
Jeanne Prater
Shareholder (Spouse/Partner): Johnson & Johnson
Employee (Spouse/Partner): Novo Nordisk
Jaime Symowicz, PhD
Nothing to disclose with regard to commercial support
TARGET AUDIENCE
• Primary care physicians
• Pain specialists
ACCREDITATION
Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Dannemiller and Spire Learning. Dannemiller is accredited by the ACCME to provide continuing medical education for physicians.
Dannemiller designates this live activity for a maximum of 0.50
AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
METHOD OF PARTICIPATION
This activity has no fee and should take approximately 30 minutes to complete. Participants should first read the objectives and other introductory CME information, then complete the pre-assessment and participate in the online case activity. To receive credit for this activity, participants must complete the post-assessment with a passing score of 80% and then complete the evaluation. This credit is valid through April 15, 2015. No credit will be given after this date. In the event you have questions about this activity or are unable to print the certificate, please e-mail Christine Kocienda at ckocienda@spirelearning.com, and a certificate will be e-mailed within 2 weeks.
This educational activity is jointly sponsored by Dannemiller and Spire Learning.
This educational activity is supported by an educational grant from Takeda Pharmaceuticals International, Inc., U.S. Region and Sucampo.
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References for Management of Opioid-induced Constipation With Darren Brenner, MD
1. Chou R, Fanciullo GJ, Fine PG, et al; American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10:113-130. (C)
2. Manchikanti L, Abdi S, Atluri S et al; American Society of Interventional Pain Physicians. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part 2-guidance. Pain Physician. 2012;15(suppl 3):S67-S116. (C)
3. Quigley C. Opioid switching to improve pain relief and drug tolerability. Cochrane Database Syst Rev. 2004;(3):CD004847. (A)
4. Thomas J. Strategies to manage constipation. J Support Oncol. 2006;4:220-223.
5. Thomas JR, Cooney GA, Slatkin NE. Palliative care and pain: new strategies for managing opioid bowel dysfunction. J Palliat Med. 2008;11(suppl 1):S1-S19.
6. Walters JB, Montagnini M. Current concepts in the management of opioid-induced constipation. J Opioid Manag. 2010;6:435-444.
7. American Gastroenterological Association, Bharucha AE, Dorn SD, Lembo A, Pressman A. American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013;144:211-217. (C)
8. Zurad EG, Johanson JF. Over-the-counter laxative polyethylene glycol 3350: an evidence-based appraisal. Curr Med Res Opin. 2011;27:1439-1452. (B)
9. Candy B, Jones L, Goodman ML et al. Laxatives or methylnaltrexone for the management of constipation in palliative care patients. Cochrane Database Syst Rev. 2011;CD003448. (A)
10. Pappagallo M. Incidence, prevalence, and management of opioid-induced bowel dysfunction. Am J Surg. 2001;182(suppl 5A):11S-18S.
11. Sobczak M, Salaga M, Storr MA, Fichna J. Physiology, signaling, and pharmacology of opioids receptors and their ligands in the gastrointestinal tract: current concepts and future perspectives. J Gastroenterol. 2013 Feb 9. [Epub ahead of print]
12. Panchal SJ, Müller-Schwefe P, Wurzelmann JI. Opioid-induced bowel dysfunction: prevalence, pathophysiology and burden. Int J Clin Pract. 2007;61:1181-1187.
13. Ford AC, Brenner DM, Schoenfeld PS. Efficacy of pharmacological therapies for the treatment of opioid-induced constipation: systematic review and meta-analysis. Am J Gastroenterol. 2013;108:1566-1574. (A)
14. Lowenstein O, Leyendecker P, Hopp M, et al. Combined prolonged-release oxycodone and naloxone improves bowel function in patients receiving opioids for moderate-to-severe non-malignant chronic pain: a randomized controlled trial. Expert Opin Pharmacother. 2009;10:531-543. (A)
15. Meissner W, Leyendecker P, Mueller-Lissner S, et al. A randomized controlled trial with prolonged-release oral oxycodone and naloxone to prevent and reverse opioid-induced constipation. Eur J Pain. 2009;13:56-64. (B)
16. Simpson K, Leyendecker P, Hopp M, et al. Fixed-ratio combination oxycodone/naloxone compared with oxycodone alone for the relief of opioid-induced constipation in moderate-to-severe noncancer pain. Curr Med Res Opin. 2008;24:3503-3512. (B)
17. Liu M, Wittbrodt E. Low-dose oral naloxone reverses opioid-induced constipation and analgesia. J Pain Symptom Manage. 2002;23:48-53. (B)
18. Michna E, Blonsky ER, Schulman S, et al. Subcutaneous methylnaltrexone for treatment of opioid-induced constipation in patients with chronic, nonmalignant pain: a randomized controlled study. J Pain. 2011;12:554-562. (A)
19. Rauck RL, Peppin JF, Israel RJ, et al. Oral Methylnaltrexone for the Treatment of Opioid-Induced Constipation in Patients with Noncancer Pain. Gastroenterology. 2012;142(suppl 1):S160. (B)
20. Thomas J, Karver S, Cooney GA, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med. 2008;358:2332-2343. (A)
21. Slatkin N, Thomas J, Lipman AG, et al. Methylnaltrexone for treatment of opioid-induced constipation in advanced illness patients. J Support Oncol. 2009;7:39-46. (A)
22. Paulson DM, Kennedy DT, Donovick RA, et al. Alvimopan: an oral, peripherally acting, mu-opioid receptor antagonist for the treatment of opioid-induced bowel dysfunction?a 21-day treatment-randomized clinical trial. J Pain. 2005;6:184-192. (A)
23. Webster L, Jansen JP, Peppin J, et al. Alvimopan, a peripherally acting mu-opioid receptor (PAM-OR) antagonist for the treatment of opioid-induced bowel dysfunction: results from a randomized, double-blind, placebo-controlled, dose-finding study in subjects taking opioids for chronic non-cancer pain. Pain. 2008;137:428-440. (A)
24. Irving G, Penzes J, Ramjattan B, et al. A randomized, placebo-controlled phase 3 trial (Study SB-767905/013) of alvimopan for opioid-induced bowel dysfunction in patients with non-cancer pain. J Pain. 2011;12:175-184. (A)
25. Jansen JP, Lorch D, Langan J, et al. A randomized, placebo-controlled phase 3 trial (study SB-767905/012) of alvimopan for opioid-induced bowel dysfunction in patients with non-cancer pain. J Pain. 2011;12:185-193. (A)
26. Methylnaltrexone Bromide [package insert]. August 23, 2013. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm. Accessed January 21, 2014.
27. National Hospice and Palliative Care Organization. NHPCO’s Facts and Figures Hospice Care in America. 2013 Edition. http://www.nhpco.org/sites/default/files/public/Statistics_Research/2013_Facts_Figures.pdf. Accessed December 10, 2013.
28. Lubiprostone [package insert]. April 19, 2013. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm. Accessed January 21, 2014.
29. Cuppoletti J, Malinowska DH, Tewari KP, et al. SPI-0211 activates T84 cell chloride transport and recombinant human ClC-2 chloride currents. Am J Physiol Cell Physiol. 2004;287:C1173-C1183.
30. Camilleri M, Bharucha AE, Ueno R, et al. Effect of a selective chloride channel activator, lubiprostone, on gastrointestinal transit, gastric sensory, and motor functions in healthy volunteers. Am J Physiol Gastrointest Liver Physiol. 2006;290:G942-G947.
31. Sloots CE, Rykx A, Cools M, et al. Efficacy and safety of prucalopride in patients with chronic noncancer pain suffering from opioid-induced constipation. Dig Dis Sci. 2010;55:2912-2921. (A)
32. McCarberg BH. Overview and treatment of opioid-induced constipation. Postgraduate Medicine. 2013;125:7-17. (B)
33. Spierings E, Joswick T, Lindner E, et al. Long-term safety and efficacy of lubiprostone in opioid-induced constipation in patients with chronic, non-cancer pain: results from a phase 3 open-label clinical trial. Abstract presented at: PainWeek 2013, Las Vegas, NV, September 5-6, 2013. (A)
34. Cryer B, Katz S, Vallejo R, Popescu A, Ueno R. A randomized study of lubiprostone for opioid-induced constipation in patients with chronic noncancer pain. Pain Med.2014 Apr 9. [Epub ahead of print]. (A)
35. Jamal MM, Mareya S, Joswick T, Ueno R. Lubiprostone significantly improves constipation induced by nonmethadone opioids in patients with chronic, noncancer pain: results from a phase 3, randomized, double-blind, placebo-controlled clinical trial. Abstract presented at: PainWeek 2013, Las Vegas, NV, September 5-6, 2013. (A)
36. Spierings E, Joswick T, Mareya S, et al. Lubiprostone for treatment of opioid-induced constipation does not interfere with opioid analgesic effects in patients with noncancer pain. Abstract presented at: PainWeek 2013, Las Vegas, NV, September 5-6, 2013. (B)
37. Alvimopan [package insert]. October 21, 2012. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm. Accessed January 21, 2014.
38. Webster L, Dhar S, Eldon M, et al. A phase 2, double-blind, randomized, placebo-controlled, dose-escalation study to evaluate the efficacy, safety, and tolerability of naloxegol in patients with opioid-induced constipation. Pain. 2013;154:1542-1550. (A)