Single-entity hydrocodone extended-release capsules in opioid-tolerant subjects with moderate-to-severe chronic low back pain: a randomized double-blind, placebo-controlled study.

Abstract

OBJECTIVE:

A single-agent, extended-release formulation of hydrocodone (HC) has been developed for treatment of chronic moderate-to-severe pain. This study was designed to examine the safety and efficacy of HC extended release in opioid-experienced adults with moderate-to-severe chronic low back pain (CLBP).

METHODS:

This multicenter, enriched enrollment, randomized withdrawal study comprised an open-label conversion/titration phase (≤6 weeks) followed by placebo-controlled, double-blind treatment (12 weeks). During the conversion/titration phase, subjects (N = 510) converted from their current opioid and were titrated to a stabilized dose of HC extended release (20-100 mg every 12 hours). During treatment, subjects (N = 151 per group) received HC extended release or placebo; rescue medication was permitted. The primary efficacy end point was mean change in average pain intensity from baseline to day 85. Response rates (30% pain improvement) and satisfaction (Subject Global Assessment of Medication) were assessed.

RESULTS:

Demographic and baseline characteristics were similar between groups. Mean ± SD change in average pain intensity score from baseline to day 85 was significantly lower in the HC extended-release treatment group vs placebo (0.48 ± 1.56 vs 0.96 ± 1.55; P = 0.008). Significantly more responders were in the treatment group (68% vs 31%; P < 0.001). Mean Subject Global Assessment of Medication scores increased significantly (0.8 ± 1.3 vs 0.0 ± 1.4; P < 0.0001), indicating greater satisfaction with HC extended release. The adverse event profile was consistent with other opioids.

CONCLUSIONS:

Extended-release HC is well tolerated and effective, without acetaminophen-associated risks of liver toxicity, for treatment of CLBP.

• Authors: Richard L Rauck, Srinivas Nalamachu, James E Wild, George S Walker, Cynthia Y Robinson, Charles S Davis, Stephen J Farr
• Journal: Pain medicine (Malden, Mass.) (Pain Med) Vol. 15 Issue 6 Pg. 975-85 (Jun 2014) ISSN: 1526-4637 [Electronic] England
• PMID: 24517082 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Wiley Periodicals, Inc.

Chemical References

• Analgesics, Opioid
• Delayed-Action Preparations
• Hydrocodone

Topics

• Adolescent
• Adult
• Aged
• Analgesics, Opioid (administration & dosage)
• Chronic Pain (diagnosis, drug therapy)
• Delayed-Action Preparations (administration & dosage)
• Double-Blind Method
• Drug Tolerance
• Female
• Humans
• Hydrocodone (administration & dosage)
• Low Back Pain (diagnosis, drug therapy)
• Male
• Middle Aged
• Pain Measurement (drug effects, methods)
• Severity of Illness Index
• Young Adult