Impact of Opioid and Cannabis Use on Low-Dose Amitriptyline Efficacy in Cyclical Vomiting Syndrome: A Real-World Study in the United Kingdom.

IF 2.9 3区医学 Q1 CLINICAL NEUROLOGY

Neurogastroenterology and Motility Pub Date : 2025-06-01 Epub Date: 2025-02-27 DOI:10.1111/nmo.70007

Mohsin F Butt, Francesca Cefalo, Caterina Sbarigia, Arkadeep Dhali, Maura Corsetti

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引用次数: 0

Abstract

Background: Central neuromodulators, specifically tricyclic antidepressants (TCAs), are prescribed as prophylactic treatment for cyclical vomiting syndrome (CVS). It is unclear whether opioids and/or cannabis affect the treatment response to neuromodulators. The aims of this study were to assess: (i) the prevalence of opioid and cannabis use among outpatients with CVS, (ii) clinical characteristics associated with opioid/cannabis use and response to a three-tiered neuromodulator treatment algorithm, and (iii) the effect of opioid/cannabis cessation on response to the treatment algorithm.

Methodology: Data from consecutive patients newly diagnosed with Rome IV CVS at a single tertiary care neurogastroenterology outpatient clinic (January 2016-June 2024) were retrospectively collected. Patients were advised to stop consuming opioids and/or cannabis and commenced a low-dose TCA.

Results: Sixty-one (46/75) percent of outpatients with CVS responded to the three-tiered treatment algorithm. Among responders, 42 (91%) patients responded to TCA alone (1st line therapy), 3 (7%) patients responded to TCA and selective serotonin reuptake inhibitor or serotonin norepinephrine reuptake inhibitor (2nd line therapy), and 1 (2%) patient required topiramate (3rd line therapy). The mean [SD] dosage of TCA among responders was 26.5 [18.3] mg. Twenty-five (33%) patients consumed opioids, 14 (19%) took cannabis, and five (7%) consumed both opioids and cannabis. While opioid cessation was associated with clinical response to the treatment algorithm (p = 0.03), opioid intake at the initial consultation was not (p = 0.2). Irritable bowel syndrome was independently associated with significantly greater odds (OR [95% CI]) of opioid consumption at baseline (6.59 [1.49-29.24], p = 0.01). Heartburn was independently associated with lower odds of response to the treatment algorithm (0.2 [0.05-0.65], p = 0.006).

Conclusion: Low-dose neuromodulators, along with opioid and cannabis cessation, may be important strategies in the management of CVS.

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阿片类药物和大麻使用对周期性呕吐综合征低剂量阿米替林疗效的影响：英国的一项真实世界研究。

背景：中枢神经调节剂，特别是三环抗抑郁药（TCAs），被处方为预防性治疗周期性呕吐综合征（CVS）。目前尚不清楚阿片类药物和/或大麻是否会影响对神经调节剂的治疗反应。本研究的目的是评估：(i)门诊CVS患者中阿片类药物和大麻使用的流行程度，（ii）与阿片类药物/大麻使用和对三层神经调节剂治疗算法的反应相关的临床特征，以及（iii）阿片类药物/大麻戒烟对治疗算法反应的影响。方法：回顾性收集2016年1月至2024年6月在单一三级护理神经胃肠病学门诊连续新诊断为Rome IV CVS的患者的数据。建议患者停止服用阿片类药物和/或大麻，并开始服用低剂量的TCA。结果：61%（46/ 75%）的CVS门诊患者对三层治疗算法有反应。在应答者中，42例（91%）患者对TCA（一线治疗）有应答，3例（7%）患者对TCA和选择性5 -羟色胺再摄取抑制剂或5 -羟色胺去甲肾上腺素再摄取抑制剂（二线治疗）有应答，1例（2%）患者需要托吡酯（三线治疗）。应答者TCA的平均[SD]剂量为26.5 [18.3]mg。25名（33%）患者服用阿片类药物，14名（19%）服用大麻，5名（7%）同时服用阿片类药物和大麻。虽然阿片类药物的停止与治疗方法的临床反应有关（p = 0.03），但在最初咨询时阿片类药物的摄入量与此无关（p = 0.2）。肠易激综合征与基线时阿片类药物摄入的独立相关（OR [95% CI]）显著增加（6.59 [1.49-29.24],p = 0.01）。胃灼热与治疗方案的应答率较低独立相关（0.2 [0.05-0.65],p = 0.006）。结论：低剂量神经调节剂，以及阿片类药物和大麻戒烟，可能是治疗CVS的重要策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurogastroenterology and Motility 医学-临床神经学

CiteScore

7.80

自引率

8.60%

发文量

178

审稿时长

3-6 weeks

期刊介绍： Neurogastroenterology & Motility (NMO) is the official Journal of the European Society of Neurogastroenterology & Motility (ESNM) and the American Neurogastroenterology and Motility Society (ANMS). It is edited by James Galligan, Albert Bredenoord, and Stephen Vanner. The editorial and peer review process is independent of the societies affiliated to the journal and publisher: Neither the ANMS, the ESNM or the Publisher have editorial decision-making power. Whenever these are relevant to the content being considered or published, the editors, journal management committee and editorial board declare their interests and affiliations.