Lack of correlation between the effective dose of fentanyl sublingual spray for breakthrough cancer pain and the around-the-clock opioid dose.

Abstract

OBJECTIVE:

To examine the relationship between the dose of fentanyl sublingual spray needed to control breakthrough cancer pain (BTCP) and the dose of around-the-clock (ATC) opioid used to control background pain.

DESIGN:

Analysis was based on the open-label, dose-titration phase (up to 26 days) of a randomized, double-blind, placebo-controlled trial.

PATIENTS:

Opioid-tolerant cancer patients (aged ≥18 years) with chronic pain of ≤moderate severity in the 24 hours before screening while receiving stable doses of scheduled ATC opioid therapy for ≥1 week and 1 to 4 episodes of BTCP per day.

INTERVENTIONS:

Fentanyl sublingual spray was initiated at 100 µg. Dose titration proceeded until a dose was reached that provided adequate pain relief for two consecutive BTCP episodes without intolerable adverse effects (AEs).

RESULTS:

Overall, 98/130 (75.4 percent) patients completed the dose-titration phase and achieved pain relief, and 73.5 percent of those who completed the titration period attained an effective dose of ≥600 µg (median effective dose, 800 µg). No clinically relevant correlation was found between effective doses of fentanyl sublingual spray for the treatment of BTCP and the ATC opioid doses used to control persistent pain (Spearman rank correlation [rs]=0.351, n=98). Sixty percent of patients reported ≥1 AE during the dose-titration phase. The most common AEs considered related to study treatment were nausea (6.2 percent), somnolence (4.6 percent), dizziness (3.8 percent), and vomiting (3.8 percent).

CONCLUSIONS:

These findings highlight the importance of titrating the dose of fentanyl sublingual spray to optimize dosing for individual patients.

• Authors: Srinivas R Nalamachu, Neha Parikh, Larry Dillaha, Richard Rauck
• Journal: Journal of opioid management (J Opioid Manag) 2014 Jul-Aug Vol. 10 Issue 4 Pg. 247-54 ISSN: 1551-7489 [Print] United States
• PMID: 25162604 (Publication Type: Clinical Trial, Phase III, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Aerosols
• Analgesics, Opioid
• Fentanyl

Topics

• Administration, Sublingual
• Adult
• Aerosols
• Aged
• Analgesics, Opioid (administration & dosage, adverse effects)
• Breakthrough Pain (diagnosis, drug therapy, etiology)
• Double-Blind Method
• Drug Administration Schedule
• Drug Tolerance
• Female
• Fentanyl (administration & dosage, adverse effects)
• Humans
• Male
• Middle Aged
• Neoplasms (complications)
• Pain Measurement
• Severity of Illness Index
• Time Factors
• Treatment Outcome