Symproic May Prevent Opioid-Induced Constipation

Among patients with cancer beginning regular treatment with opioids for pain relief, administration of Symproic (naldemedine) has been found to potentially prevent constipation, improve constipation-related quality of life and possibly prevent opioid-induced nausea and vomiting, research has shown.

Study findings from 99 patients at four academic hospitals in Japan were published in the Journal of Clinical Oncology.

Dr. Jun Hamano, study co-author and assistant professor in the Institute of Medicine at the University of Tsukuba in Japan, where he is part of the Center for Medical Liaison and Patient Support Service as well as the Center for Palliative and Supportive Care, told CURE® via email that constipation occurs in 63% to 81% of patients with cancer receiving opioids.

The study, conducted between July 2, 2021 and May 30, 2023, included patients with cancer ages 20 years and older who were starting strong opioid therapy. Patients received either 0.2 milligrams of Symproic (49 patients) once a day after breakfast for 14 days or placebo (50 patients), also once a day after breakfast for 14 days.

Researchers primarily evaluated patients’ responses via the Bowel Function Index (BFI), which they described as a three-item subjective scale developed for opioid-induced constipation, where patients estimate their ease of defecation, their feeling of incomplete bowel evacuation and their personal judgement of constipation, each on a scale of 0 to 100 with the mean of those three scores being the total score. The total score can range from 0 to 100, with higher scores indicating more severe constipation.

According to the study findings, significantly more patients in the Symproic group had a BFI of less than 28.8 on day 14 (64.6%) compared to the patients in the placebo group (17%), with a 47.6% difference between the two groups.

Likewise, after seven days 58.3% of patients in the Symproic group had a BFI of less than 28.8, compared to 17% of the patients in the placebo group.

Regarding spontaneous bowel movements, after seven days 85.4% of the Symproic group experienced at least three per week, versus 51.1% of the placebo group. In the Symproic group, 72.9% of patients have at least three complete spontaneous bowel movements at day 7, versus 36.2% of patients in the placebo group. Similarly, by day 14 87.5% of patients in the Symproic group and 53.2% of patients in the placebo group had experienced at least three spontaneous bowel movements per week, while 70.8% and 36.2% of patients, respectively, experienced at least three complete spontaneous bowel movements per week.

Use of Symproic, researchers further noted, was also associated with improved patient-reported quality of life and reduced incidence of opioid-induced nausea and vomiting when compared to patients who received placebo.

“Many [patients with cancer] require opioids for symptom relief,” Hamano said. “It is also known that many people become constipated and their quality of life declines as a result of opioid use. Therefore, our research results provide insights that can be used to improve the quality of life of cancer patients who require opioid-based symptom relief.”

Hamano stressed that, when speaking with their care providers, “it is necessary [for patients] to regularly discuss changes in bowel habits and the level of satisfaction with defecation.”

“Preventive use of [Symproic] for opioid-induced constipation may be considered, although further studies are needed to assess longer term effects and to compare with less costly alternatives,” wrote Dr. Camilla Zimmerman, an associate editor of the Journal of Clinical Oncology, in a sidebar to the study.

For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.