Comparative clinical efficacy and safety of a novel controlled-release oxycodone formulation and controlled-release hydromorphone in the treatment of cancer pain

Abstract

Controlled-release oxycodone demonstrated excellent pharmacodynamic characteristics, analgesic efficacy, and safety as compared with controlled-release hydromorphone and represents an important new therapeutic option for cancer pain management.

Safety and Efficacy of Controlled‐Release Oxycodone: A Systematic Literature Review

“…Five randomized, double-blind clinical trials compared the efficacy of controlled-release oxycodone with other long-acting opioids (Table 3). 3,[15][16][17][18] Four of them compared controlledrelease oxycodone with controlled-release morphine; no difference in analgesic efficacy between the two treatments was found. 3,15,16,18 One study reported a higher frequency of itching and scratching with morphine than with oxycodone.…”

Efficacy, tolerability and acceptability of oxycodone for cancer-related pain in adults: an updated Cochrane systematic review

“…Treatment preference did not differ significantly between CR oxycodone and CR morphine,18 19 CR oxycodone and CR hydromorphone,22 or between intravenous oxycodone followed by IR oxycodone and intravenous morphine followed by IR morphine 25 26. Gabrail et al reported no data for participant preference but found that 78.3% of participants rated oxycodone as ‘excellent,’ ‘very good’ or ‘good’ with 86.4% of the participants giving oxymorphone such ratings 20 21…”

“…Five studies either did not report adverse events or did not report them in a manner so they could be scrutinised for (and potentially included in) an evidence synthesis 12 16–19 27. One study only reported four adverse events in a transparent manner 22. The participants appeared to be adequately titrated in the majority of the studies,12 13 18–27 29–32 35–38 40–42 although this was unclear in four studies,16 17 28 34 and not the case in one study 33.…”

“…Of those studies that did perform the analyses,13 22 25 26 31 no significant differences were found between the treatment groups with the following exceptions:Drowsiness occurred more frequently during treatment with CR oxycodone compared with CR hydromorphone 22

‘Any degree’, but not severe, breathlessness occurred more often in the TD buprenorphine group than in the CR oxycodone group 31

…”

“…Eleven of the studies were crossover trials (published in 16 articles),12 16–30 and 12 were parallel-group trials (published in 13 articles),13 31–42 with 8 of the studies conducted in the USA,16 17 20 21 29 30 33 35 36 39 2 in Canada,18 22 3 in Finland,23–25 3 in China,13 40 42 3 in Italy31 34 41 and one each in Germany/Poland/Switzerland,12 Australia,28 Brazil,27 the UK37 38 and Japan/Korea 32. The length of the trials ranged from single-dose treatment to 1 year, and the studies reported the following comparisons:CR oxycodone versus IR oxycodone29 30 33 36 39CR oxycodone versus extended-release (ER) oxycodone12CR oxycodone versus CR morphine,18 19 23 24 27 31 34 35 37 38 41 42 with one of these studies including a further two arms of transdermal (TD) buprenorphine and TD fentayl,31 and one of the studies comparing two different brands of slow-release morphine to CR oxycodone42CR oxycodone versus CR hydromorphone22CR oxycodone versus ER hydromorphone13CR oxycodone versus ER oxymorphone20 21CR oxycodone versus ER tapentadol32CR oxycodone versus TD fentanyl31 40CR oxycodone versus TD buprenorphine31intravenous oxycodone versus rectal oxycodone28intravenous oxycodone followed by IR oxycodone versus intravenous morphine followed by IR morphine25 26intramuscular (IM) oxycodone vs oral oxycodone16IM oxycodone versus IM morphine versus IM codeine 17…”