About: Methylnaltrexone for the treatment of opioid-induced constipation and gastrointestinal stasis in intensive care patients. Results from the MOTION trial

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About: Methylnaltrexone for the treatment of opioid-induced constipation and gastrointestinal stasis in intensive care patients. Results from the MOTION trial Goto Sponge NotDistinct Permalink

An Entity of Type : schema:ScholarlyArticle, within Data Space : wasabi.inria.fr associated with source document(s)

Attributes	Values
type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
has title	Methylnaltrexone for the treatment of opioid-induced constipation and gastrointestinal stasis in intensive care patients. Results from the MOTION trial
Creator	Brett, Stephen Gordon, Anthony O'callaghan, David Anjum, Aisha Cross, Mary Patel, Parind Warwick, Jane
Source	PMC
abstract	PURPOSE: Constipation can be a significant problem in critically unwell patients, associated with detrimental outcomes. Opioids are thought to contribute to the mechanism of bowel dysfunction. We tested if methylnaltrexone, a pure peripheral mu-opioid receptor antagonist, could reverse opioid-induced constipation. METHODS: The MOTION trial is a multi-centre, double blind, randomised placebo-controlled trial to investigate whether methylnaltrexone alleviates opioid-induced constipation (OIC) in critical care patients. Eligibility criteria included adult ICU patients who were mechanically ventilated, receiving opioids and were constipated (had not opened bowels for a minimum 48 h) despite prior administration of regular laxatives as per local bowel management protocol. The primary outcome was time to significant rescue-free laxation. Secondary outcomes included gastric residual volume, tolerance of enteral feeds, requirement for rescue laxatives, requirement for prokinetics, average number of bowel movements per day, escalation of opioid dose due to antagonism/reversal of analgesia, incidence of ventilator-associated pneumonia, incidence of diarrhoea and Clostridium difficile infection and finally 28 day, ICU and hospital mortality. RESULTS: A total of 84 patients were enrolled and randomized (41 to methylnaltrexone and 43 to placebo). The baseline demographic characteristics of the two groups were generally well balanced. There was no significant difference in time to rescue-free laxation between the groups (Hazard ratio 1.42, 95% CI 0.82–2.46, p = 0.22). There were no significant differences in the majority of secondary outcomes, particularly days 1–3. However, during days 4–28, there were fewer median number of bowel movements per day in the methylnaltrexone group, (p = 0.01) and a greater incidence of diarrhoea in the placebo group (p = 0.02). There was a marked difference in mortality between the groups, with ten deaths in the methylnaltrexone group and two in the placebo group during days 4–28 (p = 0.007). CONCLUSION: We found no evidence to support the addition of methylnaltrexone to regular laxatives for the treatment of opioid-induced constipation in critically ill patients; however, the confidence interval was wide and a clinically important difference cannot be excluded. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-019-05913-6) contains supplementary material, which is available to authorized users.
has issue date	2020-02-03(xsd:dateTime)
bibo:doi	10.1007/s00134-019-05913-6
bibo:pmid	32016532
has license	no-cc
sha1sum (hex)	d5b587ac18b768b03df60c92f960efe460b10763
schema:url	https://doi.org/10.1007/s00134-019-05913-6
resource representing a document's title	Methylnaltrexone for the treatment of opioid-induced constipation and gastrointestinal stasis in intensive care patients. Results from the MOTION trial
has PubMed Central identifier	PMC7223905
has PubMed identifier	32016532
schema:publication	Intensive Care Med
resource representing a document's body	covid:d5b587ac18b768b03df60c92f960efe460b10763#body_text
is schema:about of	named entity 'dysfunction' named entity 'BOWEL DYSFUNCTION' named entity 'MECHANISM' named entity 'OUTCOMES' named entity 'TESTED' named entity 'SIGNIFICANT' covid:arg/d5b587ac18b768b03df60c92f960efe460b10763 named entity 'opioid-induced constipation' named entity 'mu-opioid receptor' named entity 'mechanism' named entity 'Methylnaltrexone' named entity 'bowel dysfunction' named entity 'Opioids' named entity 'methylnaltrexone' named entity 'gastrointestinal' named entity 'opioid' named entity 'study drugs' named entity 'bowel movements' named entity 'placebo group' named entity 'ICU' named entity 'phase III trial' named entity 'bowel movements' named entity 'placebo' named entity 'methylnaltrexone' named entity 'methylnaltrexone' named entity 'regression analyses' named entity 'laxation' named entity 'survival analyses' named entity 'critically ill patients' named entity 'methylnaltrexone' named entity 'gastric emptying' named entity 'opioid antagonist' named entity 'placebo group' named entity 'constipation' named entity 'placebo' named entity 'placebo group' named entity 'sedation' named entity 'sensitivity analysis' named entity 'double-blinded' named entity 'placebo-controlled' named entity 'placebo' named entity '28 days' named entity 'ICU' named entity 'quality control' named entity 'follow-up' named entity 'informed consent' named entity 'effect size' named entity 'sedation' named entity 'opioid-induced constipation' named entity 'double blind' named entity 'control group' named entity 'constipation' named entity 'constipation' named entity 'antagonist' named entity 'critical care' named entity 'constipation' named entity 'residual volume' named entity 'opioids' named entity 'Hammersmith' named entity 'clinical characteristics' named entity 'sample size' named entity 'ICU' named entity 'randomly selected' named entity 'Bristol-Myers Squibb' named entity 'blood cultures' named entity 'opioid' named entity 'placebo controlled trial' named entity 'opioid' named entity 'opiate' named entity 'placebo group' named entity 'double-blind' named entity 'HCA International' named entity 'adverse events' named entity 'bowel movements' named entity 'West Drayton'

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