{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:19:14Z","timestamp":1777915154756,"version":"3.51.4"},"reference-count":14,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T00:00:00Z","timestamp":1626393600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Opioid-induced constipation (OIC) remains the most common adverse event associated with opioid use. Treatment with more novel and costly agents (such as peripheral \u03bc-opioid receptor antagonists [PAMORAs]) may be indicated in patients with laxative-refractory OIC. Three PAMORAs are U.S. Food and Drug Administration approved for managing OIC\u2014methylnaltrexone (FDA approved in 2008), naloxegol (in 2014), and naldemedine (in 2017). These drugs are indicated only in limited scenarios. Their contemporary patterns of use and burden of spending remain unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate the trends in use and expenditures for the three PAMORAs approved for treating OIC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective cross-sectional study using the 2014\u20132018 Medicare Part D Prescription Drug Event data and the 2018 Part D Prescriber Public Use File.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Prescribers and beneficiaries using PAMORAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements:<\/jats:title>\n                    <jats:p>The annual spending, number of beneficiaries, number of claims, and spending per beneficiary and claim for each PAMORA. The distribution by prescriber specialty using PAMORA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>From 2014 to 2018, aggregate spending on PAMORAs increased, from $13.6 to $150.9 million, and use increased, from 4221 to 72,592 beneficiaries. After FDA approval in 2014, naloxegol overtook methylnaltrexone in the number of users in 2015 and spending in 2016. In 2018, 6989 unique prescribers used any PAMORA. Among them, the most common specialties\/professions were family practice (20.2%), internal medicine (18.0%), and nurse practitioner (15.4%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Our findings\u2014significant and increasing expenditure on PAMORAs, and broad use across specialties\u2014serve as a call for defining and implementing appropriate use of PAMORAs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/jpm.2021.0021","type":"journal-article","created":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T17:01:07Z","timestamp":1618851667000},"page":"1236-1239","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Use of Peripheral \u03bc-Opioid Receptor Antagonists for Treating Opioid-Induced Constipation among US Medicare Beneficiaries from 2014 to 2018"],"prefix":"10.1177","volume":"24","author":[{"given":"Naveen","family":"Premnath","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Sumarsono","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramy","family":"Sedhom","sequence":"additional","affiliation":[{"name":"Department of Palliative Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David H.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ishwaria M.","family":"Subbiah","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center, Houston, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sydney M.","family":"Dy","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0875-4731","authenticated-orcid":false,"given":"Arjun","family":"Gupta","sequence":"additional","affiliation":[{"name":"Medical Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,7,16]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2008.00495.x"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-020-05364-6"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.3285"},{"key":"e_1_3_4_5_2","first-page":"687","article-title":"Impact of opioid-induced constipation on healthcare resource utilization and costs for cancer pain patients receiving continuous opioid therapy","volume":"27","author":"Fine PG","year":"2019","unstructured":"Fine PG, , Chen YW, , Wittbrodt E, , Datto C: Impact of opioid-induced constipation on healthcare resource utilization and costs for cancer pain patients receiving continuous opioid therapy. 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