P4058 - Peripherally Acting U-Opioid Receptor Antagonists Are Underutilized in Opioid-Induced Constipation

Katie Liu, MD, Ariana Chen, BS, Pranav Rajaram, BS, Grayson Buning, BS, Allen Lee, MD, Prashant Singh, MD
University of Michigan, Ann Arbor, MI

Introduction: Peripherally acting u-opioid receptor antagonists (PAMORAs) are a safe and effective medication for patients with opioid-induced constipation (OIC). However, there are no studies to date exploring rates of utilization of PAMORAs. We aim to study patients with OIC who have failed first line treatment with laxatives and determine factors that influence the utilization of PAMORAs.

Methods: Patients diagnosed with OIC from 2018 to 2023 were retrospectively identified at a tertiary care center. Patients were considered eligible for PAMORAs based on the AGA guidelines (i.e. patients who failed a scheduled use of at least 2 laxatives). Data on PAMORAs prescription (yes or no), age, sex, BMI, race, comorbidity index, insurance provider, and specialty of prescribing provider were collected. Logistic regression and chi-squared analysis were used to analyze factors influencing PAMORA utilization.

Results: We identified 281 patients with OIC during the study period. Of these, 204 (73%) were eligible for a PAMORA, of which only 58 (28%) were prescribed a PAMORA. Patients eligible for PAMORA were similar to those not eligible with regards to demographic characteristics, insurance coverage, and comorbidity index except for BMI which was significantly lower (mean 27.7 vs 29.9, p = 0.01). Rates of eligibility significantly differed based on provider specialty, with 85% eligibility in the GI department compared to 58% in primary care, 68% in oncology, 80% in palliative care, and 71% in all other specialties (p=0.003). No differences in demographic characteristics, insurance provider, and comorbidity index were seen in those offered PAMORAs vs not. However, there was a significant difference in prescribing patterns based on provider specialty (p < 0.001). Although GI specialists saw less than half of the eligible patients, they offered PAMORAs at the highest rate of 59% compared to non-GI specialists (13-16%) or primary care providers (18%) (Table 1). Multivariate logistic regression analysis showed 2-fold increased odds of being offered a PAMORA if the provider was from the GI department compared to all non-GI providers (OR 2.35, 95% CI 1.5-3.1, p < 0.001).

Discussion: PAMORAs are underutilized in patients with OIC. GI prescribers offer PAMORAs at a higher rate than other departments, and being seen in GI independently increases the likelihood of a patient receiving a PAMORA. This suggests underutilization may be due to a lack of awareness and further education about PAMORAs is warranted.


Disclosures:


Katie Liu, MD, Ariana Chen, BS, Pranav Rajaram, BS, Grayson Buning, BS, Allen Lee, MD, Prashant Singh, MD. P4058 - Peripherally Acting U-Opioid Receptor Antagonists Are Underutilized in Opioid-Induced Constipation, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.