Abstract
Purpose
This study aimed to synthesize the available evidence on the efficacy and safety of transdermal (TD) buprenorphine.
Methods
We searched studies in electronic databases. Randomized controlled trials (RCTs) assessing the efficacy of TD buprenorphine comparing with placebo or other comparator drug in relieving cancer pain were included. The primary end points are patient-reported pain intensity and pain relief. For dichotomous data, the summary relative risk (RR) and its 95 % confidence interval (CI) were derived using random-effect model in view of heterogeneity testing.
Results
Eight clinical trials (n = 909) were included in the analysis. Only a few studies reported the same outcome in similar way, which created difficulty in the pooling of outcome data. Two studies (n = 288) assessed ‘responders’ and showed a significant difference between TD buprenorphine and placebo in all three doses of TD buprenorphine, 35.5, 52.5, or 70 μg/h (RR 1.74, 95 % CI 1.31–2.32; I 2 0 %); the numbers-needed-to-treat was 5.8 (3.9–11). Two studies (n = 331) showed a comparable requirement for rescue SL buprenorphine between TD buprenorphine and placebo (RR 1.25, 95 % CI 0.84–1.88; I 2 0 %). The preferred outcome measure ‘50 % pain relief’ was not reported in any included studies. On the basis of summary quality, further research is likely to have an important impact on our confidence in the estimate.
Conclusion
Transdermal buprenorphine has an increasing role for the relief of cancer pain. Further research in this field is needed. Multicentre studies in this field using a common protocol and strict supervision will be more practicable.
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References
Aurilio C, Pace MC, Pota V, Sansone P, Barbarisi M, Grella E, Passavanti MB et al (2009) Opioids switching with transdermal systems in chronic cancer pain. J Exp Clin Cancer Res 28(61)
Berde CB, Sethna NF (2002) Analgesics for the treatment of pain in children. N Engl J Med 347(14):1094–1103
Bohme K, Likar R (2003) Efficacy and tolerability of a new opioid analgesic formulation, buprenorphine transdermal therapeutic system (TDS) in the treatment of patients with chronic pain. A randomised, double blind, placebo-controlled study. Pain Clin 15:193–202
Cherny N, Ripamonti C, Pereira J, Davis C, Fallon M, McQuay H et al (2001) Strategies to manage the adverse effects of oral morphine: an evidence-based report. J Clin Oncol 19:2542–2554
Cook RJ, Sackett DL (1995) The number needed to treat: a clinically useful measure of treatment effect. BMJ 310:452–454
Freye E, Anderson-Hillemacher A, Ritzdorf I, Levy JV (2007) Opioid rotation from high-dose morphine to transdermal buprenorphine (Transtec®) in chronic pain patients. Pain Pract 7:123–129
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J et al (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394
Hanks GW, Kaasa S, Mercadante S, Olarte JMN, Poulain P, Radbruch L (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Expert working group of the research network of the European association for palliative care. Br J Cancer 84((5):587–593
Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org
IASP (International Associations of Pain) (2010) Proceedings of the Congress of the European Federation of IASP. In: http://www.iasp-pain.org
Khroyan TV, Polgar WE, Jiang F, Zaveri NT, Toll L (2009) Nociceptin/orphaning FQ receptor activation attenuates anti-nociception induced by mixed nociception/orphaning FQ/mu-opioid receptor agonists. J Pharmacol Exp Ther 331(3):946–953
Levy MH (1996) Pharmacologic treatment of cancer pain. N Engl J Med 335(6):1124–1132
Likar R, Lorenz V, Korak-Leiter M, Kager I, Sittl R (2007) Transdermal buprenorphine patches applied in a 4-day regimen versus a 3-day regimen: a single-site, phase III, randomised, open-label, cross-over comparison. Clin Ther 29(8):1591–1606
Lutfy K, Cowan A (2004) Buprenorphine: a unique drug with complex pharmacology. Curr Neuropharmacol 2(4):395–402
Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097
Pace MC, Passavanti MB, Grella E, Mazzariello L, Maisto M, Barbarisi M et al (2007) Buprenorphine in long-term control of chronic pain in cancer patients. Front Biosci 12:1291–1299
Pergolizzi J, Böger RH, Budd K, Dahan A, Erdine S, Hans G et al (2008) Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract 8(4):287–313
Pergolizzi J, Aloisi AM, Dahan A, Filitz J, Langford R, Likar R et al (2010) Current knowledge of buprenorphine and its unique pharmacological profile. Pain Pract 10(5):428–450
Poulain P, Denier W, Douma J, Hoerauf K, Samija M, Sopata M et al (2008) Efficacy and safety of transdermal buprenorphine: a randomised, placebo-controlled trial in 289 patients with severe cancer pain. J Pain Symptom Manag 36(2):117–125
Quigley C (2004) Opioid switching to improve pain relief and drug tolerability. Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD004847. doi:10.1002/14651858.CD004847
Reisfield GM, Wilson GR (2007) Rational use of sublingual opioids in palliative medicine. Palliat Med 10(2):465–475
Sittl R, Griessinger N, Likar R (2003) Analgesic efficacy and tolerability of transdermal buprenorphine in patients with inadequately controlled chronic pain related to cancer and other disorders: a multicenter, randomised, double-blind, placebo controlled trial. Clin Ther 25:150–168
Skaer TL (2006) Transdermal opioids for cancer pain. Health Qual Life Outcomes 4(24)
Sorge J, Sittl R (2004) Transdermal buprenorphine in the treatment of chronic pain: results of a phase III, multicenter, randomised, double-blind, placebo-controlled study. Clin Ther 26(11):1808–1820
Sterne JAC, Sutton AJ, Ioannidis JPA, Terrin N, Jones DR, Lau J et al (2011) Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 343:d4002
Straube S, Derry S, McQuay HJ, Moore RA (2008) Enriched enrolment: definition and effects of enrichment and dose in trials of pregabalin and gabapentin in neuropathic pain. A systematic review. Br J Clin Pharmacol 66:266–275
Tassinari D, Drudi F, Rosati M, Maltoni M (2011) Transdermal opioids as front line treatment of moderate to severe cancer pain: a systemic review. Palliat Med 25(5):478–487
Van den Beuken-van Everdingen MH, De Rijke JM, Kessels AG, Schouten HC, Van Kleef M, Patijn J (2007) High prevalence of pain in patients with cancer in a large population-based study in the Netherlands. Pain 132:312–320
WHO (World Health Organization) (1996) Cancer pain relief, 2nd edn. World Health Organization, Geneva
WHO (World Health Organization) (2000) Narcotic and psychotropic drugs achieving balance in national opioids control policy: guidelines for assessment. WHO [Other: WHO/EDM/QSM/2000.4]
WHO (World Health Organization) (2009) WHO guidelines: cancer control. WHO, Geneva
Wirz S, Wittmann M, Schenk M, Schroeck A, Schaefer N, Mueller M et al (2009) Gastrointestinal symptoms under opioid therapy: a prospective comparison of oral sustained-release hydromorphone, transdermal fentanyl, and transdermal buprenorphine. Eur J Pain 13(7):737–743
Wolff RF, Aune D, Truyers C, Hernandez AV, Misso K, Riemsma R et al (2012) Systematic review of efficacy and safety of buprenorphine versus fentanyl or morphine in patients with chronic moderate to severe pain. CMRO 28:833–845
Yaksh TL, Wallace MS (2011). Ch 18. Opioids, analgesia, and pain management: introduction. In: Brunton LL, Chabner BA, Knollmann BC (eds) Goodman & Gilman’s the pharmacological basis of therapeutics. 12th edn. The McGraw-Hill Companies, [http://www.accessmedicine.com/content.aspx?aID=16663974]
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Naing, C., Aung, K., Racloz, V. et al. Safety and efficacy of transdermal buprenorphine for the relief of cancer pain. J Cancer Res Clin Oncol 139, 1963–1970 (2013). https://doi.org/10.1007/s00432-013-1487-0
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DOI: https://doi.org/10.1007/s00432-013-1487-0