Alvimopan, for postoperative ileus following bowel resection - A pooled analysis of phase III studies

被引:115
|
作者
Delaney, Conor P.
Wolff, Bruce G.
Viscusi, Eugene R.
Senagore, Anthony J.
Fort, John G.
Du, Wei
Techner, Lee
Wallin, Bruce
机构
[1] Case Western Reserve Univ, Univ Hosp Cleveland, Dept Surg, Div Colorectal Surg, Cleveland, OH 44106 USA
[2] Mayo Clin, Div Colon & Rectal Surg, Rochester, MN USA
[3] Thomas Jefferson Univ, Jefferson Med Coll, Dept Anesthesiol, Philadelphia, PA 19107 USA
[4] Med Univ Ohio, Toledo, OH USA
[5] Adolor Corp, Exton, PA USA
关键词
D O I
10.1097/01.sla.0000232538.72458.93
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To obtain further analysis regarding specific outcomes and alvimopan doses in bowel resection (BR) patients. Summary Background Data: Although postoperative ileus (POI) is common after BR, there is currently no recognized treatment or prevention available. Alvimopan, a novel, peripherally active muopioid receptor antagonist, accelerated GI recovery after BR or hysterectomy in 3 phase III trials. Methods: A pooled retrospective subset analysis of BR patients in alvimopan phase III trials was performed. Randomized BR patients received alvimopan 6 mg (n = 397), 12 mg (n = 413), or placebo (n = 402) >= 2 hours before surgery and twice daily until hospital discharge for <= 7 days. The primary endpoint of each trial was time to recovery of GI function. Hospital discharge order (DCO) written, readmission, and morbidities were also assessed. Cox proportional hazard models were used to analyze treatment effects on time-to-event endpoints. Results: Alvimopan (6 or 12 mg) significantly accelerated GI recovery (GI-3; hazard ratio = 1.28 and 1.38, respectively; P <= 0.001 for both). Alvimopan significantly accelerated time to DCO written by 16 hours for 6 mg and 18 hours for 12 mg (P < 0.001 for both) from a mean of 147 hours for placebo. Alvimopan-treated patients had reduced postoperative morbidity compared with placebo, and incidence of prolonged hospital stay or readmission was significantly reduced (P < 0.001). Tolerability profiles were similar among groups. Conclusions: Alvimopan significantly accelerated GI recovery in BR patients. A 12-mg dose provided more consistent benefits across both sexes and all ages. Postoperative morbidity rates, prolonged hospital stay, and rates of hospital readmission were significantly reduced. Alvimopan reduces the consequences of POI after BR.
引用
收藏
页码:355 / 363
页数:9
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