This post-authorization observational safety study (PASS) monitors clinically important identified and potential risks within a cohort of patients treated with naloxegol, including the occurrence of bowel perforation, acute myocardial infarction (MI), stroke, cardiovascular (CV)-specific mortality, all-cause mortality, hypertension, opioid withdrawal, abdominal pain, diarrhea, syncope, and change in pain severity. This study is part of a broader post-marketing commitment to augment routine evaluation of the safety profile of naloxegol in clinical practice.
The overall research goal for this study is to provide additional data to characterize the safety of naloxegol in the indicated population, grouped by cancer or non-cancer, and within at-risk vulnerable non-cancer populations identified in the naloxegol risk management plan (RMP) by describing type and frequency of identified and potential risks (including bowel perforation, acute MI, stroke, CV-specific mortality, all-cause mortality, hypertension, opioid withdrawal, abdominal pain, diarrhea, syncope, and change in pain severity) in patients ≥18 years of age who were treated with opioids chronically and subsequently treated with naloxegol in routine post-authorization use. The primary objective of the study is to assess the incidence risk of bowel perforation, acute MI, stroke, all-cause mortality, and hypertension in patients treated with naloxegol (Naloxegol Inception Cohort, (NIC)), grouped by cancer or non cancer, a Concurrent Reference Cohort (CRC) by cancer or non-cancer, and by pre-specified non-cancer sub-populations that include patients aged ≥65 years, pregnant patients, patients with prior CV, patients with prior renal or hepatic impairment, patients with concurrent methadone use, and patients with concurrent use of cytochrome P450 (CYP) 3A inhibitors/inducer or P-glycoprotein (Pgp) modulators. An exploratory objective of the study is to assess the incidence risk of CV-specific mortality, opioid withdrawal, abdominal pain, diarrhea, syncope, and change in pain severity in patients treated with naloxegol (NIC) grouped by cancer and non cancer, a CRC grouped by cancer or non cancer, and by pre-specified non-cancer sub-populations that include patients aged ≥65 years, pregnant patients, patients with prior cardiovascular risk, patients with prior renal or hepatic impairment, patients with concurrent methadone use, and patients with concurrent use of CYP3A inhibitors/inducer or Pgp modulators.
Study Type
OBSERVATIONAL
Enrollment
non-interventional study where patients are exposed to naloxegol during normal clinical practice
non-interventional study where patients are exposed to non-peripherally acting mu-opioid receptor antagonist (PAMORA) laxative
Research Site
Utrecht, Netherlands
Research Site
Sutton, Surrey, United Kingdom
Presence (yes/no) of bowel perforation
Presence of a diagnostic or procedure code
Time frame: Can occur anytime through study completion, given no fixed follow-up timepoints, which can range from 1 day to 7 years
Presence (yes/no) of acute MI
Presence of a diagnostic code for acute MI, a diagnostic code for electrocardiogram supportive of MI or cardiac enzyme lab tests with positive results
Time frame: Can occur anytime through study completion, given no fixed follow-up timepoints, which can range from 1 day to 7 years
Presence (yes/no) of stroke
Presence of a diagnostic code for cerebral, cerebellar haemorrhage or infarction, cerebral embolism, stroke or cerebrovascular accident
Time frame: Can occur anytime through study completion, given no fixed follow-up timepoints, which can range from 1 day to 7 years
Presence (yes/no) of all-cause mortality
Record of death
Time frame: Can occur anytime through study completion, given no fixed follow-up timepoints, which can range from 1 day to 7 years
Presence (yes/no) of hypertension
Presence of a hypertension (HT) diagnostic code where no record of HT or treatment for HT was observed in the baseline, or a record of change in HT treatment type or dose from baseline was observed.
Time frame: Can occur anytime through study completion, given no fixed follow-up timepoints, which can range from 1 day to 7 years
Presence of (yes/no) CV-specific mortality
Record of death that indicates the cause was a CV event
Time frame: Can occur anytime through study completion, given no fixed follow-up timepoints, which can range from 1 day to 7 years
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10,000
Presence of (yes/no) opioid withdrawal
Presence of a diagnosis or symptom code
Time frame: Can occur anytime through study completion, given no fixed follow-up timepoints, which can range from 1 day to 7 years
Presence of (yes/no) abdominal pain
Presence of a diagnosis or symptom code
Time frame: Can occur anytime through study completion, given no fixed follow-up timepoints, which can range from 1 day to 7 years
Presence of (yes/no) diarrhea
Presence of a diagnosis or symptom code
Time frame: Can occur anytime through study completion, given no fixed follow-up timepoints, which can range from 1 day to 7 years
Presence of (yes/no) syncope
Presence of a diagnosis code
Time frame: Can occur anytime through study completion, given no fixed follow-up timepoints, which can range from 1 day to 7 years
Presence of (yes/no) change in pain severity
At least a doubling in opioid dose based on the morphine milligram equivalents (MME) from baseline
Time frame: Can occur anytime through study completion, given no fixed follow-up timepoints, which can range from 1 day to 7 years