PAMORAs in Cancer and Non-Cancer Opioid-Induced Constipation: A Systematic Review, Meta-Analysis, and Personalized Value-Based Evaluation Integrating Clinical and Patient-Reported Outcomes

Background

Opioid-induced constipation (OIC) is a frequent and clinically relevant complication of long-term opioid therapy in both cancer and non-cancer populations, negatively affecting symptoms, treatment adherence, and health-related quality of life. Peripherally acting μ-opioid receptor antagonists (PAMORAs) represent a mechanism-based therapeutic approach targeting peripheral opioid effects while preserving analgesic activity. However, the overall value of PAMORAs, integrating clinical outcomes, patient-reported benefits, and health-economic implications, has not been comprehensively assessed.