Giovambattista Zeppetella1, Andrew Davies2, Indra Eijgelshoven3, Jeroen P Jansen4. 1. St. Clare Hospice, Hastingwood, Essex, United Kingdom. Electronic address: john.zeppetella@stclarehospice.org.uk. 2. St. Luke's Cancer Centre, The Royal Surrey County Hospital, Guildford, Surrey, United Kingdom. 3. Mapi, Houten, The Netherlands. 4. Mapi, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA.
Abstract
CONTEXT: With many medications available for the management of breakthrough cancer pain (BTCP), physicians may require additional guidance in selecting an appropriate medication to suit an individual patient's needs. OBJECTIVES: To identify all the evidence and assess the relative clinical value of currently approved BTCP medications. METHODS: Following a systematic literature search (2007-2010), the results of 10 randomized controlled trials investigating the effects of BTCP medications (intranasal fentanyl spray [INFS], fentanyl pectin nasal spray, fentanyl sublingual tablets, fentanyl buccal soluble film, fentanyl buccal tablets, oral transmucosal fentanyl citrate, and morphine sulfate immediate release) were synthesized using a network meta-analysis. The main outcome was pain intensity difference (PID) relative to placebo up to 60 minutes after the intake of medication. RESULTS: INFS, fentanyl pectin nasal spray, fentanyl buccal tablet, and oral transmucosal fentanyl citrate showed greater PIDs relative to placebo than other BTCP medications 15 minutes after intake. All other medications showed greater PIDs relative to placebo at 30 minutes, except morphine sulfate immediate release, which did not show efficacy over placebo until 45 minutes. Only INFS produced clinically meaningful pain relief (absolute PID ≥2) at 15 minutes. CONCLUSION: From current evidence, although all BTCP medications provided pain relief within the time frames assessed, transmucosal fentanyl medications achieved a greater level of pain relief in a shorter time frame than placebo or oral morphine.
CONTEXT: With many medications available for the management of breakthrough cancer pain (BTCP), physicians may require additional guidance in selecting an appropriate medication to suit an individual patient's needs. OBJECTIVES: To identify all the evidence and assess the relative clinical value of currently approved BTCP medications. METHODS: Following a systematic literature search (2007-2010), the results of 10 randomized controlled trials investigating the effects of BTCP medications (intranasal fentanyl spray [INFS], fentanyl pectin nasal spray, fentanyl sublingual tablets, fentanyl buccal soluble film, fentanyl buccal tablets, oral transmucosal fentanyl citrate, and morphine sulfate immediate release) were synthesized using a network meta-analysis. The main outcome was pain intensity difference (PID) relative to placebo up to 60 minutes after the intake of medication. RESULTS: INFS, fentanyl pectin nasal spray, fentanyl buccal tablet, and oral transmucosal fentanyl citrate showed greater PIDs relative to placebo than other BTCP medications 15 minutes after intake. All other medications showed greater PIDs relative to placebo at 30 minutes, except morphine sulfate immediate release, which did not show efficacy over placebo until 45 minutes. Only INFS produced clinically meaningful pain relief (absolute PID ≥2) at 15 minutes. CONCLUSION: From current evidence, although all BTCP medications provided pain relief within the time frames assessed, transmucosal fentanyl medications achieved a greater level of pain relief in a shorter time frame than placebo or oral morphine.
Authors: François Lamontagne; Robert A Fowler; Neill K Adhikari; Srinivas Murthy; David M Brett-Major; Michael Jacobs; Timothy M Uyeki; Constanza Vallenas; Susan L Norris; William A Fischer; Thomas E Fletcher; Adam C Levine; Paul Reed; Daniel G Bausch; Sandy Gove; Andrew Hall; Susan Shepherd; Reed A Siemieniuk; Marie-Claude Lamah; Rashida Kamara; Phiona Nakyeyune; Moses J Soka; Ama Edwin; Afeez A Hazzan; Shevin T Jacob; Mubarak Mustafa Elkarsany; Takuya Adachi; Lynda Benhadj; Christophe Clément; Ian Crozier; Armando Garcia; Steven J Hoffman; Gordon H Guyatt Journal: Lancet Date: 2017-10-17 Impact factor: 79.321
Authors: Francisco Villegas; Verónica Martínez-Borba; Carlos Suso-Ribera; Diana Castilla; Irene Zaragoza; Azucena García-Palacios; Carlos Ferrer Journal: Int J Environ Res Public Health Date: 2021-06-03 Impact factor: 4.614