Summary

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• This summary is based on the review of three systematic review(s)/meta-analysis(es). ^[1-3]
• PAMORAs (Peripherally acting mu-opioid receptor antagonists), including methylnaltrexone, naloxegol, naldemedine, and alvimopan, were superior to placebo in alleviating opioid-induced constipation (OIC), with naloxegol improving bowel function indices and stool consistency, and naldemedine generating a higher frequency of spontaneous bowel movements (SBMs) than alvimopan and naloxegol.
• In cancer patients, both naldemedine and naloxegol demonstrated effectiveness and safety for OIC, potentially enhancing quality of life in this subgroup.
• Comparatively, naldemedine outperformed naloxegol in increasing SBMs, while oral methylnaltrexone showed a more rapid onset in reducing OIC symptoms than naloxegol.
• Common adverse effects of PAMORAs, including naloxegol and naldemedine, primarily involved gastrointestinal symptoms such as diarrhea and flatulence, with diarrhea noted as the most frequent side effect across these treatments.
• Serious adverse events were rare; however, some cardiovascular treatment-emergent adverse effects (TEAs) were observed with methylnaltrexone, though a definitive link to the drug was unclear, possibly reflecting underlying patient conditions.