Kazuhiko Koike1, Takeshi Terui2, Tomokazu Nagasako3, Iori Horiuchi3, Takayuki Machino3, Toshiro Kusakabe2, Yasuo Hirayama2, Hiroyoshi Mihara2, Michiaki Yamakage4, Junji Kato5, Takuji Nishisato6, Kunihiko Ishitani3. 1. Division of Palliative Medicine, Sapporo Kiyota Hospital, 1-1-1-1 Shinei, Kiyota-ku, Sapporo, Hokkaido, 004-0831, Japan. kkoikekyh@gmail.com. 2. Division of Internal Medicine, Higashi Sapporo Hospital, Sapporo, Hokkaido, Japan. 3. Division of Palliative Medicine, Higashi Sapporo Hospital, Sapporo, Hokkaido, Japan. 4. Department of Anesthesiology, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan. 5. Department of Medical Oncology and Hematology, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan. 6. Division of Palliative Medicine, Sapporo Kiyota Hospital, 1-1-1-1 Shinei, Kiyota-ku, Sapporo, Hokkaido, 004-0831, Japan.
Abstract
PURPOSE: The recommended dosing interval for transdermal fentanyl is every 72 h. However, some patients will have "end-of-dose failure," which may be seen as an increase of episodes of severe pain flares at the third day after application of the patch. A new once-a-day fentanyl patch was developed in Japan since 2010. This study aimed to assess the efficacy of the once-a-day fentanyl citrate patch for patients with cancer-related pain receiving the 72-h transdermal fentanyl not lasting 72 h. METHODS: We performed a cross-sectional retrospective analysis of 445 inpatients with the 72-h transdermal fentanyl at Higashi Sapporo Hospital. We could switch to the once-a-day fentanyl citrate patch if patients reported inadequate pain relief beyond 48 h after application of the 72-h transdermal fentanyl. Patients recorded baseline scores for background pain intensity (PI) and the frequency of use of daily rescue medication for breakthrough cancer pain (BTcP). RESULTS: Of all patients, 10.1% showed the increase in PI of 30% or more baseline PI on the third day after application of the 72-h transdermal fentanyl. Of patients, 84.4% were converted from equivalent dose of the 72-h transdermal fentanyl to the once-a-day fentanyl citrate patch. On the third day after switching, 60.5% of patients showed a reduction of more than 30% from baseline PI. Switching to the once-a-day fentanyl citrate patch significantly reduced the mean frequency of daily rescue dose for BTcP. CONCLUSIONS: A once-a-day fentanyl citrate patch provided stable pain control. Its use may be considered as the dominant strategy for patients receiving a 72-h transdermal fentanyl not lasting 72 h.
PURPOSE: The recommended dosing interval for transdermal fentanyl is every 72 h. However, some patients will have "end-of-dose failure," which may be seen as an increase of episodes of severe pain flares at the third day after application of the patch. A new once-a-day fentanyl patch was developed in Japan since 2010. This study aimed to assess the efficacy of the once-a-day fentanyl citrate patch for patients with cancer-related pain receiving the 72-h transdermal fentanyl not lasting 72 h. METHODS: We performed a cross-sectional retrospective analysis of 445 inpatients with the 72-h transdermal fentanyl at Higashi Sapporo Hospital. We could switch to the once-a-day fentanyl citrate patch if patients reported inadequate pain relief beyond 48 h after application of the 72-h transdermal fentanyl. Patients recorded baseline scores for background pain intensity (PI) and the frequency of use of daily rescue medication for breakthrough cancer pain (BTcP). RESULTS: Of all patients, 10.1% showed the increase in PI of 30% or more baseline PI on the third day after application of the 72-h transdermal fentanyl. Of patients, 84.4% were converted from equivalent dose of the 72-h transdermal fentanyl to the once-a-day fentanyl citrate patch. On the third day after switching, 60.5% of patients showed a reduction of more than 30% from baseline PI. Switching to the once-a-day fentanyl citrate patch significantly reduced the mean frequency of daily rescue dose for BTcP. CONCLUSIONS: A once-a-day fentanyl citrate patch provided stable pain control. Its use may be considered as the dominant strategy for patients receiving a 72-h transdermal fentanyl not lasting 72 h.
Authors: Augusto Caraceni; Geoffrey Hanks; Stein Kaasa; Michael I Bennett; Cinzia Brunelli; Nathan Cherny; Ola Dale; Franco De Conno; Marie Fallon; Magdi Hanna; Dagny Faksvåg Haugen; Gitte Juhl; Samuel King; Pål Klepstad; Eivor A Laugsand; Marco Maltoni; Sebastiano Mercadante; Maria Nabal; Alessandra Pigni; Lukas Radbruch; Colette Reid; Per Sjogren; Patrick C Stone; Davide Tassinari; Giovambattista Zeppetella Journal: Lancet Oncol Date: 2012-02 Impact factor: 41.316