Cochrane · systematic review · CD006332
Mu‐opioid antagonists for opioid‐induced bowel dysfunction in people with cancer and people receiving palliative care
Candy, B, Jones, L, Vickerstaff, V, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
36
current version
GRADE rated
24
No studies
11
Included studies
NR
No studies 11 · 30.6%Ungraded 1 · 2.8%Very low 4 · 11.1%Low 17 · 47.2%Moderate 3 · 8.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyNaldemedine compared to placebo for opioid‐induced bowel dysfunction in people with cancer irrespective of whether they were receiving palliative care
Population: people with cancer irrespective of whether receiving palliative care and with opioid‐induced bowel dysfunction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Laxation response: risk of spontaneous rescue‐free bowel movementsain the short termb Naldemedine vs placebo | no estimate extracted | NR | No studies |
Laxation response: risk of spontaneous rescue‐free bowel movementsain the medium termc Naldemedine vs placebo | RR 2 [1.59, 2.52] | 2 studies · 418 participants | Moderate Downgraded: risk of bias, imprecision |
Laxation response: patient assessment of change in bowel status at the end of trial Naldemedine vs placebo | no estimate extracted | NR | No studies |
Symptoms of opioid withdrawalein the medium termc Naldemedine vs placebo | MD 0.3 | 1 study · 112 participants | Very low Downgraded: risk of bias, imprecision |
Serious adverse eventsh Naldemedine vs placebo | RR 3.34 [0.85, 13.15] | 2 studies · 418 participants | Low Downgraded: risk of bias, imprecision |
Adverse events Naldemedine vs placebo | RR 1.49 [1.19, 1.87] | 2 studies · 418 participants | Moderate Downgraded: risk of bias, imprecision |
Low dose naldemedine compared to higher doses for opioid‐induced bowel dysfunction in people with cancer irrespective of whether they were receiving palliative care
Population: people with cancer irrespective of whether they are receiving palliative care and with opioid‐induced bowel dysfunction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Laxation response: risk of spontaneous rescue‐free bowel movements in the short terma Low dose naldemedine vs higher doses | no estimate extracted | NR | No studies |
Laxation response: risk of spontaneous rescue‐free bowel movements in the medium termb,c Low dose naldemedine vs higher doses | RR 0.69 [0.53, 0.89] | 1 study · 111 participants | Low Downgraded: risk of bias, imprecision |
Laxation response: patient assessment of change bowel status at end of trial Low dose naldemedine vs higher doses | no estimate extracted | NR | No studies |
Symptoms of opioid withdrawalfin the medium termb Low dose naldemedine vs higher doses | no estimate extracted | 1 study · 112 participants | Low Downgraded: risk of bias, imprecision |
Serious adverse eventsg Low dose naldemedine vs higher doses | RR 0.25 [0.03, 2.17] | 1 study · 112 participants | Low Downgraded: risk of bias, imprecision |
Adverse events Low dose naldemedine vs higher doses | RR 0.84 [0.67, 1.06] | 1 study · 112 participants | Low Downgraded: risk of bias, imprecision |
Naloxone compared with placebo for opioid‐induced bowel dysfunction in people with cancer and receiving palliative care
Population: people with cancer and receiving palliative care with opioid‐induced bowel dysfunction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Laxation response: risk of spontaneous rescue‐free bowel movements in the short terma Naloxone vs placebo | no estimate extracted | NR | No studies |
Laxation response: risk of spontaneous rescue‐free bowel movements in the medium termb Naloxone vs placebo | no estimate extracted | NR | No studies |
Laxation response: patient assessment of change in bowel status at the end of trial Naloxone vs placebo | no estimate extracted | NR | No studies |
Symptoms of opioid withdrawal in the medium term Naloxone vs placebo | no estimate extracted | 1 study · 17 participants | Ungraded |
Serious adverse events Naloxone vs placebo | no estimate extracted | 1 study · 17 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Naloxone vs placebo | no estimate extracted | NR | No studies |
Naloxone + oxycodone prolonged release tablets compared with oxycodone prolonged‐released tablets for opioid‐induced bowel dysfunction in people with cancer irrespective of whether they were receiving palliative care
Population: people with cancer irrespective of whether they were receiving palliative care opioid‐induced bowel dysfunction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Laxation response: risk of spontaneous rescue‐free bowel movements in the short terma Naloxone + oxycodone prolonged release tablets vs oxycodone prolonged‐released tablets | no estimate extracted | NR | No studies |
Laxation response: risk of spontaneous rescue‐free bowel movements in the medium termb Naloxone + oxycodone prolonged release tablets vs oxycodone prolonged‐released tablets | no estimate extracted | NR | No studies |
Laxation response: Patient assessment of change in bowel statuscat the end of trial Naloxone + oxycodone prolonged release tablets vs oxycodone prolonged‐released tablets | no estimate extracted | 2 studies · 212 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Symptoms of opioid withdrawalfin the medium termb Naloxone + oxycodone prolonged release tablets vs oxycodone prolonged‐released tablets | no estimate extracted | 1 study · 133 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Serious adverse eventsg Naloxone + oxycodone prolonged release tablets vs oxycodone prolonged‐released tablets | RR 0.68 [0.44, 1.06] | 3 studies · 362 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events Naloxone + oxycodone prolonged release tablets vs oxycodone prolonged‐released tablets | RR 1.01 [0.87, 1.18] | 3 studies · 362 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Methylnaltrexone compared to placebo for opioid‐induced bowel dysfunction in people receiving palliative care irrespective of whether they had cancer
Population: people receiving palliative care irrespective of whether they had cancer with opioid‐induced bowel dysfunction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Laxation response: risk of spontaneous rescue‐free bowel movementsain the short termb Methylnaltrexone vs placebo | RR 2.97 [2.13, 4.13] | 2 studies · 287 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Laxation response: risk of spontaneous rescue‐free bowel movementsain the medium terme Methylnaltrexone vs placebo | RR 8.15 [4.76, 13.95] | 2 studies · 305 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Laxation response: patient assessment of change in bowel statusgat the end of trial Methylnaltrexone vs placebo | RR 2.32 [1.64, 3.27] | 2 studies · 287 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Symptoms of opioid withdrawalhin the medium term Methylnaltrexone vs placebo | no estimate extracted | 1 study · 133 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Serious adverse eventsi Methylnaltrexone vs placebo | RR 0.59 [0.38, 0.93] | 2 studies · 364 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events Methylnaltrexone vs placebo | RR 1.17 | 3 studies · 518 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Methylnaltrexone lower dose compared to higher dose for opioid‐induced bowel dysfunction in people receiving palliative care irrespective of whether they had cancer
Population: people receiving palliative care irrespective of whether they had cancer with opioid‐induced bowel dysfunction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Laxation response: risk of spontaneous rescue‐free bowel movementsain the short termb Methylnaltrexone lower dose vs higher dose | RR 0.21 [0.03, 1.41] | 2 studies · 135 participants | Low Downgraded: risk of bias, imprecision |
Laxation response: risk of spontaneous rescue‐free bowel movementsa,in the medium terme Methylnaltrexone lower dose vs higher dose | RR 2.91 [0.82, 10.39] | 1 study · 26 participants | Very low Downgraded: risk of bias, imprecision |
Laxation response: patient assessment of change in bowel statusgat the end of trial Methylnaltrexone lower dose vs higher dose | RR 0.98 [0.71, 1.35] | 1 study · 102 participants | Low Downgraded: risk of bias, imprecision |
Symptoms of opioid withdrawal in the medium term Methylnaltrexone lower dose vs higher dose | no estimate extracted | 1 study · 102 participants | Low Downgraded: risk of bias, imprecision |
Serious adverse events Methylnaltrexone lower dose vs higher dose | no estimate extracted | NR | No studies |
Adverse events Methylnaltrexone lower dose vs higher dose | RR 1 [1, 1] | 2 studies · 135 participants | Low Downgraded: risk of bias, imprecision |
Naldemedine compared to placebo for opioid‐induced bowel dysfunction in cancer and people receiving palliative care
Population: people with cancer and people receiving palliative care with opioid‐induced bowel dysfunction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Laxation response within 24 hours of dose Naldemedine vs placebo | no estimate extracted | NR | No studies |
Laxation response between day 1 and day 14a Naldemedine vs placebo | RR 1.93 [1.36, 2.74] | 1 study · 225 participants | Moderate Downgraded: risk of bias |
Effect on analgesia: opioid withdrawalc Naldemedine vs placebo | no estimate extracted | 1 study · 225 participants | Moderate Downgraded: risk of bias |
Effect on analgesia: pain intensity Naldemedine vs placebo | no estimate extracted | NR | No studies |
Serious adverse eventsa Naldemedine vs placebo | no estimate extracted | 1 study · 225 participants | Low Downgraded: risk of bias, imprecision |
Adverse eventsa Naldemedine vs placebo | RR 1.36 [1.04, 1.79] | 1 study · 225 participants | Moderate Downgraded: risk of bias |
Lower‐dose naldemedine compared to higher‐dose naldemedine for opioid‐induced bowel dysfunction in cancer and people receiving palliative care
Population: people with cancer and people receiving palliative care with opioid‐induced bowel dysfunction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Laxation response within 24 hours of dose Lower‐dose naldemedine vs higher‐dose naldemedine | no estimate extracted | NR | No studies |
Laxation response between day 1 and day 14a Lower‐dose naldemedine vs higher‐dose naldemedine | RR 0.73 [0.55, 0.95] | 1 study · 226 participants | Moderate Downgraded: risk of bias |
Effect on analgesia: opioid withdrawal Lower‐dose naldemedine vs higher‐dose naldemedine | no estimate extracted | NR | No studies |
Effect on analgesia: pain intensity Lower‐dose naldemedine vs higher‐dose naldemedine | no estimate extracted | NR | No studies |
Serious adverse events Lower‐dose naldemedine vs higher‐dose naldemedine | no estimate extracted | NR | No studies |
Adverse events Lower‐dose naldemedine vs higher‐dose naldemedine | no estimate extracted | NR | No studies |
Naloxone compared with placebo for cancer and people receiving palliative care with opioid‐induced bowel dysfunction
Population: people with cancer and people receiving palliative care with opioid‐induced bowel dysfunction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Laxation response within 24 hours of a dose Naloxone vs placebo | no estimate extracted | NR | No studies |
Laxation response between day 1 and day 14 Naloxone vs placebo | no estimate extracted | NR | No studies |
Effect on analgesia: opioid withdrawal Naloxone vs placebo | no estimate extracted | NR | No studies |
Effect on analgesia: pain intensitya Naloxone vs placebo | no estimate extracted | 1 study · 17 participants | Very low Downgraded: risk of bias, imprecision |
Serious adverse events Naloxone vs placebo | no estimate extracted | NR | No studies |
Adverse events Naloxone vs placebo | no estimate extracted | NR | No studies |
Oxycodone/naloxone prolonged release tablets compared with oxycodone prolonged‐released tablets for opioid‐induced bowel dysfunction
Population: people with cancer and people receiving palliative care with opioid‐induced bowel dysfunction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Laxation response within 24 hours of dose Oxycodone/naloxone prolonged release tablets vs oxycodone prolonged‐released tablets | no estimate extracted | NR | No studies |
Laxation response between day 1 and day 14 Oxycodone/naloxone prolonged release tablets vs oxycodone prolonged‐released tablets | no estimate extracted | NR | No studies |
Effect on analgesia: opioid withdrawalc Oxycodone/naloxone prolonged release tablets vs oxycodone prolonged‐released tablets | no estimate extracted | 1 study · 184 participants | Moderate Downgraded: risk of bias |
Effect on analgesia: pain intensitya Oxycodone/naloxone prolonged release tablets vs oxycodone prolonged‐released tablets | no estimate extracted | 1 study · 184 participants | Moderate Downgraded: risk of bias |
Serious adverse events Oxycodone/naloxone prolonged release tablets vs oxycodone prolonged‐released tablets | RR 2 [0.62, 6.41] | 1 study · 184 participants | Low Downgraded: risk of bias, imprecision |
Adverse events Oxycodone/naloxone prolonged release tablets vs oxycodone prolonged‐released tablets | RR 1.08 [0.94, 1.24] | 2 studies · 234 participants | Moderate Downgraded: risk of bias |
Methylnaltrexone compared to placebo for opioid‐induced bowel dysfunction in cancer and people receiving palliative care
Population: people with cancer and people receiving palliative care with opioid‐induced bowel dysfunction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Laxation response within 24 hours of dosea Methylnaltrexone vs placebo | RR 2.77 [1.91, 4.04] | 2 studies · 287 participants | Moderate Downgraded: risk of bias |
Laxation response between day 1 and day 14 (specifically within 4 hours after 4 or more of the 7 doses)a Methylnaltrexone vs placebo | RR 9.98 [4.96, 20.09] | 2 studies · 305 participants | Moderate Downgraded: risk of bias, imprecision |
Effect on analgesia: opioid withdrawald Methylnaltrexone vs placebo | MD 0 | 2 studies · 236 participants | Moderate Downgraded: risk of bias |
Effect on analgesia: pain intensitye Methylnaltrexone vs placebo | MD 0.2 | 2 studies · 287 participants | Low Downgraded: risk of bias |
Serious adverse events Methylnaltrexone vs placebo | RR 0.59 [0.38, 0.93] | 2 studies · 364 participants | Moderate Downgraded: risk of bias |
Adverse events Methylnaltrexone vs placebo | RR 1.17 | 3 studies · 518 participants | Low Downgraded: risk of bias |
Lower‐dose methylnaltrexone compared to higher‐dose methylnaltrexone for opioid‐induced bowel dysfunction in cancer and people receiving palliative care
Population: people with cancer and people receiving palliative care with opioid‐induced bowel dysfunction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Laxation response within 24 hours of first dosea Lower‐dose methylnaltrexone vs higher‐dose methylnaltrexone | RR 0.82 [0.41, 1.66] | 2 studies · 135 participants | Low Downgraded: risk of bias, imprecision |
Laxation responsea Lower‐dose methylnaltrexone vs higher‐dose methylnaltrexone | RR 0.47 [0.18, 1.25] | 1 study · 33 participants | Low Downgraded: risk of bias, imprecision |
Effect on analgesia: opioid withdrawalc Lower‐dose methylnaltrexone vs higher‐dose methylnaltrexone | no estimate extracted | 1 study · 102 participants | Low Downgraded: risk of bias, imprecision |
Effect on analgesia: pain intensityd Lower‐dose methylnaltrexone vs higher‐dose methylnaltrexone | no estimate extracted | 1 study · 102 participants | Low Downgraded: risk of bias, imprecision |
Serious adverse event Lower‐dose methylnaltrexone vs higher‐dose methylnaltrexone | no estimate extracted | NR | No studies |
Adverse event Lower‐dose methylnaltrexone vs higher‐dose methylnaltrexone | RR 1 [1, 1] | 2 studies · 135 participants | Low Downgraded: risk of bias, imprecision |