Details

Autor(en) / Beteiligte

• Riley, Julia, FRCP, MD
• Branford, Ruth, MRCP, PhD
• Droney, Joanne, MRCP, PhD
• Gretton, Sophy, MRCP, PhD
• Sato, Hiroe, MD, PhD
• Kennett, Alison, RGN
• Oyebode, Christina, BSc
• Thick, Michael, FRCS
• Wells, Athol, FRCP, MD
• Williams, John, FRCA
• Welsh, Ken, FRCP (Hons), PhD
• Ross, Joy, FRCP, PhD

Titel

Morphine or Oxycodone for Cancer-Related Pain? A Randomized, Open-Label, Controlled Trial

Ist Teil von

• Journal of pain and symptom management, 2015-02, Vol.49 (2), p.161-172

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2015

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Context There is wide interindividual variation in response to morphine for cancer-related pain; 30% of patients do not have a good therapeutic outcome. Alternative opioids such as oxycodone are increasingly being used, and opioid switching has become common clinical practice. Objectives To compare clinical response to oral morphine vs. oral oxycodone when used as first-line or second-line (after switching) treatment in patients with cancer-related pain. Methods In this prospective, open-label, randomized, controlled trial (ISRCTN65155201) with a selected crossover phase, patients with cancer-related pain were randomized to receive either oral morphine or oxycodone as first-line treatment. Dose was individually titrated until the patient reported adequate pain control. Patients who did not respond to the first-line opioid (either because of inadequate analgesia or unacceptable adverse effects) were switched to the alternative opioid. Results Two hundred patients were recruited. On intention-to-treat analysis ( n  = 198, morphine 98, oxycodone 100), there was no significant difference between the numbers of patients responding to morphine (61/98 = 62%) or oxycodone (67/100 = 67%) when used as a first-line opioid. Similarly, there was no significant difference in subsequent response when patients were switched to either morphine (8/12 = 67%) or oxycodone (11/21 = 52%). Per-protocol analysis demonstrated a 95% response rate when both opioids were available. There was no difference in adverse reaction scores between morphine and oxycodone either in first-line responders or nonresponders. Conclusion In this population, there was no difference between analgesic response or adverse reactions to oral morphine and oxycodone when used as a first- or second-line opioid. These data provide evidence to support opioid switching to improve outcomes.