Getting “Travis-y”: Stroke and AFib, Naloxegol for Opioid Constipation


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This week: Cryptogenic Stroke and Atrial Fibrillation, Naloxegol for Opioid-Induced Constipation

Fahad and Amol want you to:

1. Appreciate the importance of subclinical atrial fibrillation in cryptogenic stroke and consider longer monitoring to detect it.

2. Recognize Naloxegol as a targeted therapy for opioid-induced constipation that is more effective than placebo but its effectiveness has not been compared directly with existing laxative therapies.

Continuing Medical Education

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The papers

David Gladstone et al. Atrial Fibrillation in Patients with Cryptogenic Stroke. NEJM. 2014; 370:2467-2477.

William Chey et al. Naloxegol for Opioid-Induced Constipation in Patients with Noncancer Pain. NEJM. 2014;370:2387-2396.

Other articles mentioned

Tommaso Sanna et al. Cryptogenic stroke and underlying atrial fibrillation. NEJM. 2014;370(26):2478–2486. doi:10.1056/NEJMoa1313600.

Good stuff

Fahad:

http://www.nytimes.com/2014/06/22/us/dr-arnold-relman-outspoken-medical-editor-dies-at-91.html

http://www.nytimes.com/2012/03/20/science/a-drumbeat-on-profit-takers.html

Relman AS. The new medical-industrial complex. New England Journal of Medicine. 1980;303(17):963–970. doi:10.1056/NEJM198010233031703.

Amol:

The Longitude Prize 2014

 

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2 comments

  1. Andreas Laupacis

    HI Amol. I enjoyed this podcast. Two quick questions regarding the Naloxegol trial: 1) was pain control similar in the Naloxegol and control groups, and 2) were there any important side-effects in patients treated with Naloxegol?

  2. Amol Verma

    Hi Andreas, glad you liked it! Thanks for the questions.

    1. Naloxegol didn’t have any effect on either pain or daily opioid dose (suggesting that the putative mechanism of PEGylation reducing its likelihood of crossing the blood brain barrier, holds true).

    2. Adverse events led to discontinuation of the study drug in about 10% of patients on the 25 mg dose of Naloxegol and about 5% of the patients on the 12.5 mg dose and 5% of patients in the placebo arm. The primary side-effects were GI: abdominal pain, diarrhea, nausea, flatulence, and vomiting. There was no evidence of a significant increase in cardiovascular events or opioid withdrawal (these will continue to be monitored if the drug enters wider clinical use).

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