Neues aus der Cochrane Library: µ-Opioidantagonisten für die Behandlung der opioidinduzierten Magen-Darm-Störungen

Zusammenfassung

Obstipation und andere Magen-Darm-Störungen stellen eine häufige Nebenwirkung einer kurzfristigen postoperativen oder auch chronischen Opioidtherapie dar. Zur Bedeutung von µ-Opioidantagonisten zur Vermeidung bzw. Behandlung dieser Komplikationen konnten die Review-Autoren 23 Studien identifizieren. Die Datenlage zur Sicherheit und Wirksamkeit der traditionellen Antagonisten wie Naloxon oder Nalbuphin ist unzureichend. Die Ergebnisse der Studien zu den neueren, selektiv peripher-wirksamen Antagonisten Alvimopan bzw. Methylnaltrexon sind vielversprechend. Durch Methylnaltrexon konnte in vier Studien an gesunden Probanden eine signifikante Verkürzung der gastrointestinalen Passagezeit um 52 min erreicht werden. Für Alvimopan konnte in fünf Studien eine signifikante Verbesserung der Hazard Ratio’s für unterschiedliche Endpunkte (Stuhlabgang, Verträglichkeit fester Nahrung) im postoperativen Setting gezeigt werden. Es bleibt abzuwarten, inwieweit sich diese Ergebnisse an verschiedenen Patientengruppen im größeren Umfang reproduzieren lassen. Auch steht die Einordnung dieser noch nicht zugelassenen Medikamente insbesondere im Hinblick auf andere pharmakologische (z. B. Lactulose) und nicht pharmakologische Interventionen aus.

Abstract

Constipation and other gastrointestinal symptoms are frequent adverse effects of either short-term postoperative or chronic opioid therapy. The review authors have identified 23 studies to evaluate the efficacy of µ-opioid antagonists for the prevention and treatment of these complications. The data on safety and efficacy of the traditional antagonists naloxone and nalbuphine are insufficient. The results of studies with the newer, peripherally-acting antagonists alvimopan and methylnaltrexone are promising. Methylnaltrexone resulted in four studies with healthy probands in a significant shortening of the gastrointestinal transit time (-52 min). In the postoperative setting, five studies showed a significant improvement of the hazard ratios for different outcomes (e. g., bowel movement, tolerance of solid food) in the alvimopan group. Future studies will be needed to show whether these results can be reproduced in different patient groups on a larger scale. Also, with regard to other pharmacological (e. g., lactulose) and non-pharmacological interventions, the role of the above-mentioned not yet approved medications needs to be defined.

Cochrane Library - Metaanalyse - systematische Übersichtsarbeit - µ-Opioidantagonisten - opioidinduzierte Magen-Darm-Störungen

Cochrane Library - meta-analysis - systematic review - µ-opioid antagonists - opioid-induced bowel dysfunction

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