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Pain Management
Five phase III trials of alvimopan for the management of POI after BR have development, and further study is needed to sufficiently compare the safety
been completed.
11,13–15,45
In these trials, oral alvimopan 12mg in conjunction and efficacy of alvimopan and methylnaltrexone in patients with OBD, OIC,
with a standardized accelerated post-operative care pathway significantly and POI. If approved, these agents could allow clinicians the option of safely
accelerated recovery of upper (toleration of solid food) and lower (first BM) treating their patients’ pain with the necessary doses of opioids without
GI function in patients undergoing BR via laparotomy by 11–26 hours many of the currently expected GI-related adverse side effects. ■
compared with patients who received a standardized accelerated
post-operative care pathway alone.
11,13–15,45
Alvimopan is currently under Conflict of Interest
review by the FDA for the management of POI after BR, based on the Dr Leslie has received research funding and served as an advisor for
positive results of these trials in the BR population. Adolor Corporation, Exton, Pennsylvania; GlaxoSmithKline, Philadelphia,
Pennsylvania; Progenics Pharmaceuticals, Tarrytown, New York; and
Discussion Wyeth, Madison, New Jersey.
Agents in this new PAM-OR antagonist class have the potential to mitigate
the GI-related adverse effects often seen with both acute and chronic Acknowledgements
opioid-based pain management. Both agents in this class accelerate GI The author would like to thank Kerry A O’Connor, PhD, ProEd
function after BR, reduce time to BM, increase the proportion of patients Communications, Inc., for her medical editorial assistance with this
with BMs after chronic opioid therapy, and do not appear to compromise manuscript, and Amy Rachfal, PhD, ProEd Communications, Inc., for her
central opioid-based analgesia. These agents are at different stages of review and constructive help with the final draft.
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96 US GASTROENTEROLOGY REVIEW 2007
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