Adverse effects of transdermal opiates treating moderate-severe cancer pain in comparison to long-acting morphine

A meta-analysis and systematic review of the literature

Davide Tassinari, Sergio Sartori, Emiliano Tamburini, Emanuela Scarpi, William Raffaeli, Paola Tombesi, Marco Maltoni

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Background: To assess the adverse effects of transdermal opiates treating moderate-severe cancer pain in comparison with slow release oral morphine. Methods: A systematic review of the literature in the MEDLINE and EMBASE databases from 1966 to June 2007 was independently performed by two authors. All phase 3 randomized trials comparing transdermal opiates and slow-release oral morphine in the treatment of moderatesevere cancer pain were considered eligible and included in the analysis. The primary end point was the overall adverse effects odds ratio (OR); secondary end points were the overall gastrointestinal adverse effects, constipation, nausea, somnolence, patients' preference, and trial withdrawal. Heterogeneity was analyzed using the Mantel-Haenszel test, and outcome analysis was performed using a random effect model; an error lower than 5% was assumed as statistically significant. Results: Four trials met the selection criteria. The safety of transdermal opiates (fentanyl and buprenorphine) and slow-release oral morphine was analyzed in 425 patients. A significant difference in favor of transdermal opiates was observed for constipation (OR = 0.38, p <0.001), and patients' preference (OR = 0.43, p = 0.014, in the three trials investigating transdermal fentanyl). No significant differences were observed for overall adverse effects, overall gastrointestinal adverse effects, overall neurologic adverse effects, nausea, somnolence, hypoventilation, trial withdrawal, and changes in opiate treatments. Conclusion: Although no difference in the overall adverse effect profile exists between transdermal opiates and slow release oral morphine, the difference in some adverse effects (mainly constipation) seems to favor transdermal opiates in the preference of patients with moderate-severe cancer pain.

Original languageEnglish
Pages (from-to)492-501
Number of pages10
JournalJournal of Palliative Medicine
Volume11
Issue number3
DOIs
Publication statusPublished - Apr 1 2008

Fingerprint

Opiate Alkaloids
Morphine
Meta-Analysis
Patient Preference
Constipation
Odds Ratio
Fentanyl
Nausea
Hypoventilation
Buprenorphine
Cancer Pain
MEDLINE
Patient Selection
Nervous System
Databases
Safety

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Adverse effects of transdermal opiates treating moderate-severe cancer pain in comparison to long-acting morphine : A meta-analysis and systematic review of the literature. / Tassinari, Davide; Sartori, Sergio; Tamburini, Emiliano; Scarpi, Emanuela; Raffaeli, William; Tombesi, Paola; Maltoni, Marco.

In: Journal of Palliative Medicine, Vol. 11, No. 3, 01.04.2008, p. 492-501.

Research output: Contribution to journalArticle

@article{2783b1386f1b464e8e96ccece2ec0bdd,
title = "Adverse effects of transdermal opiates treating moderate-severe cancer pain in comparison to long-acting morphine: A meta-analysis and systematic review of the literature",
abstract = "Background: To assess the adverse effects of transdermal opiates treating moderate-severe cancer pain in comparison with slow release oral morphine. Methods: A systematic review of the literature in the MEDLINE and EMBASE databases from 1966 to June 2007 was independently performed by two authors. All phase 3 randomized trials comparing transdermal opiates and slow-release oral morphine in the treatment of moderatesevere cancer pain were considered eligible and included in the analysis. The primary end point was the overall adverse effects odds ratio (OR); secondary end points were the overall gastrointestinal adverse effects, constipation, nausea, somnolence, patients' preference, and trial withdrawal. Heterogeneity was analyzed using the Mantel-Haenszel test, and outcome analysis was performed using a random effect model; an error lower than 5{\%} was assumed as statistically significant. Results: Four trials met the selection criteria. The safety of transdermal opiates (fentanyl and buprenorphine) and slow-release oral morphine was analyzed in 425 patients. A significant difference in favor of transdermal opiates was observed for constipation (OR = 0.38, p <0.001), and patients' preference (OR = 0.43, p = 0.014, in the three trials investigating transdermal fentanyl). No significant differences were observed for overall adverse effects, overall gastrointestinal adverse effects, overall neurologic adverse effects, nausea, somnolence, hypoventilation, trial withdrawal, and changes in opiate treatments. Conclusion: Although no difference in the overall adverse effect profile exists between transdermal opiates and slow release oral morphine, the difference in some adverse effects (mainly constipation) seems to favor transdermal opiates in the preference of patients with moderate-severe cancer pain.",
author = "Davide Tassinari and Sergio Sartori and Emiliano Tamburini and Emanuela Scarpi and William Raffaeli and Paola Tombesi and Marco Maltoni",
year = "2008",
month = "4",
day = "1",
doi = "10.1089/jpm.2007.0200",
language = "English",
volume = "11",
pages = "492--501",
journal = "Journal of Palliative Medicine",
issn = "1096-6218",
publisher = "Mary Ann Liebert Inc.",
number = "3",

}

TY - JOUR

T1 - Adverse effects of transdermal opiates treating moderate-severe cancer pain in comparison to long-acting morphine

T2 - A meta-analysis and systematic review of the literature

AU - Tassinari, Davide

AU - Sartori, Sergio

AU - Tamburini, Emiliano

AU - Scarpi, Emanuela

AU - Raffaeli, William

AU - Tombesi, Paola

AU - Maltoni, Marco

PY - 2008/4/1

Y1 - 2008/4/1

N2 - Background: To assess the adverse effects of transdermal opiates treating moderate-severe cancer pain in comparison with slow release oral morphine. Methods: A systematic review of the literature in the MEDLINE and EMBASE databases from 1966 to June 2007 was independently performed by two authors. All phase 3 randomized trials comparing transdermal opiates and slow-release oral morphine in the treatment of moderatesevere cancer pain were considered eligible and included in the analysis. The primary end point was the overall adverse effects odds ratio (OR); secondary end points were the overall gastrointestinal adverse effects, constipation, nausea, somnolence, patients' preference, and trial withdrawal. Heterogeneity was analyzed using the Mantel-Haenszel test, and outcome analysis was performed using a random effect model; an error lower than 5% was assumed as statistically significant. Results: Four trials met the selection criteria. The safety of transdermal opiates (fentanyl and buprenorphine) and slow-release oral morphine was analyzed in 425 patients. A significant difference in favor of transdermal opiates was observed for constipation (OR = 0.38, p <0.001), and patients' preference (OR = 0.43, p = 0.014, in the three trials investigating transdermal fentanyl). No significant differences were observed for overall adverse effects, overall gastrointestinal adverse effects, overall neurologic adverse effects, nausea, somnolence, hypoventilation, trial withdrawal, and changes in opiate treatments. Conclusion: Although no difference in the overall adverse effect profile exists between transdermal opiates and slow release oral morphine, the difference in some adverse effects (mainly constipation) seems to favor transdermal opiates in the preference of patients with moderate-severe cancer pain.

AB - Background: To assess the adverse effects of transdermal opiates treating moderate-severe cancer pain in comparison with slow release oral morphine. Methods: A systematic review of the literature in the MEDLINE and EMBASE databases from 1966 to June 2007 was independently performed by two authors. All phase 3 randomized trials comparing transdermal opiates and slow-release oral morphine in the treatment of moderatesevere cancer pain were considered eligible and included in the analysis. The primary end point was the overall adverse effects odds ratio (OR); secondary end points were the overall gastrointestinal adverse effects, constipation, nausea, somnolence, patients' preference, and trial withdrawal. Heterogeneity was analyzed using the Mantel-Haenszel test, and outcome analysis was performed using a random effect model; an error lower than 5% was assumed as statistically significant. Results: Four trials met the selection criteria. The safety of transdermal opiates (fentanyl and buprenorphine) and slow-release oral morphine was analyzed in 425 patients. A significant difference in favor of transdermal opiates was observed for constipation (OR = 0.38, p <0.001), and patients' preference (OR = 0.43, p = 0.014, in the three trials investigating transdermal fentanyl). No significant differences were observed for overall adverse effects, overall gastrointestinal adverse effects, overall neurologic adverse effects, nausea, somnolence, hypoventilation, trial withdrawal, and changes in opiate treatments. Conclusion: Although no difference in the overall adverse effect profile exists between transdermal opiates and slow release oral morphine, the difference in some adverse effects (mainly constipation) seems to favor transdermal opiates in the preference of patients with moderate-severe cancer pain.

UR - http://www.scopus.com/inward/record.url?scp=41149155227&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=41149155227&partnerID=8YFLogxK

U2 - 10.1089/jpm.2007.0200

DO - 10.1089/jpm.2007.0200

M3 - Article

VL - 11

SP - 492

EP - 501

JO - Journal of Palliative Medicine

JF - Journal of Palliative Medicine

SN - 1096-6218

IS - 3

ER -