Efficacy and Safety of Fentanyl Compared With Morphine among Adult Patients with Cancer: A Meta-Analysis

Abstract

Background: Cancer pain is experienced by numerous patients; thus, the main pain-relieving opioid analgesics, fentanyl and morphine, are of great importance. However, their analgesic efficacy and safety are different among individuals and are still controversial. The aim of this study was to compare the safety and efficacy of fentanyl and morphine among patients with cancer. Methods: We performed a meta-analysis by searching PubMed and the Cochrane Library up to 01 April 2019. The search terms were fentanyl, morphine, opioids and cancer pain. All randomised controlled trials comparing fentanyl and morphine were included in the analysis. Results: Overall, the initial search identified 2970 published studies; among them, 9 studies were included in the efficacy analysis and 8 studies were included in the safety analysis. The oral morphine versus oral transmucosal fentanyl subgroup analysis showed a mean difference(MD)=0.47[Confidence interval(CI):0.35-0.58] with an overall effect, Z=8.10, P<.00001. The outcome of the oral morphine versus nasal/transdermal fentanyl subgroup indicated a MD=0.20[CI:0.3-0.37] with an overall effect, Z=2.24 and P=.02. For the oral morphine versus buccal/sublingual fentanyl subgroup, the analysis revealed a MD=1.80[CI:1.35-2.25] with an overall effect, Z=7.87 and P<.00001. The oral morphine versus other forms of fentanyl subgroup showed a MD=0.70[95%CI:0.34-1.06] with the test for the overall effect, Z=3.81 and P=.0001. Constipation, drowsiness, confusion and dry mouth were more common in the morphine group than in the fentanyl group, with a risk ratio=0.60[

Efficacy of reconstituted intravenous fentanyl to sublingual solution versus oral morphine syrup for breakthrough pain among patients with chronic gynecologic cancer pain: A randomized, double‐blind, placebo‐controlled trial

“…These findings are consistent with a related case series reporting the use of IFS 13 . These findings are also consistent with clinical trials evaluating various rapid‐acting fentanyl formulations showing superiority over OM 10 . The reduction in the pain intensity in the IFS group at 4.2 was comparable with that of sublingual fentanyl citrate tablet reported the number at 3.3, whereas the level in the OM group at 1.0 was comparable with related trials reporting the number at 1.4 15 …”

“…In the current study, the mean pain intensity when the participants asked for BTP study medication was severe, with a mean of 8.6. This intensity was higher than that of related studies 10,15,16 . The tolerability to BTP before asking for medications might have been higher among our participants.…”

“…This intensity was higher than that of related studies. 10,15,16 The tolerability to BTP before asking for medications might have been higher among our participants.…”

“…9 Several randomized studies and subsequent meta-analyses found that rapidacting fentanyl formulations are more effective than OM in controlling BTP. 10,11 However, commercially available rapid-acting fentanyl formulations are expensive and widely unavailable in many countries. 4 On the contrary, intravenous fentanyl is relatively inexpensive and available worldwide.…”

“…Rapid‐acting fentanyl formulations reach its peak within 5 min and have 30–45 min duration of action 9 . Several randomized studies and subsequent meta‐analyses found that rapid‐acting fentanyl formulations are more effective than OM in controlling BTP 10,11 . However, commercially available rapid‐acting fentanyl formulations are expensive and widely unavailable in many countries 4 .…”