Safety of tapentadol compared with other opioids in chronic pain treatment: network meta-analysis of randomized controlled and withdrawal trials

Freynhagen, Rainer; Elling, Christian; Radic, Tatjana; Sohns, Melanie; Liedgens, Hiltrud; James, Daniel J.; McCool, Rachael; Edwards, Mary

doi:10.1080/03007995.2020.1832977

Cited by 16 publications

(11 citation statements)

References 64 publications

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“…The increase in tapentadol prescriptions is surprising. There are few clinical trials comparing the efficacy of tapentadol with other SO and most are of low quality, as are studies on the long-term safety and efficacy of tapentadol [5,7,39]. In fact, France (2017) and Canada (2018) decided to stop funding tapentadol for CNCP because of the lack of evidence.…”

Section: Discussionmentioning

confidence: 99%

Trends in the Prescription of Strong Opioids for Chronic Non-Cancer Pain in Primary Care in Catalonia: Opicat-Padris-Project

et al. 2022

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In chronic non-cancer pain (CNCP), evidence of the effectiveness of strong opioids (SO) is very limited. Despite this, their use is increasingly common. To examine SO prescriptions, we designed a descriptive, longitudinal, retrospective population-based study, including patients aged ≥15 years prescribed SO for ≥3 months continuously in 2013–2017 for CNCP in primary care in Catalonia. Of the 22,691 patients included, 17,509 (77.2%) were women, 10,585 (46.6%) were aged >80 years, and most had incomes of <€18,000 per year. The most common diagnoses were musculoskeletal diseases and psychiatric disorders. There was a predominance of transdermal fentanyl in the defined daily dose (DDD) per thousand inhabitants/day, with the greatest increase for tapentadol (312% increase). There was an increase of 66.89% in total DDD per thousand inhabitants/day for SO between 2013 (0.737) and 2017 (1.230). The mean daily oral morphine equivalent dose/day dispensed for all drugs was 83.09 mg. Transdermal fentanyl and immediate transmucosal release were the largest cost components. In conclusion, there was a sustained increase in the prescription of SO for CNCP, at high doses, and in mainly elderly patients, predominantly low-income women. The new SO are displacing other drugs.

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Section: Discussionmentioning

confidence: 99%

Trends in the Prescription of Strong Opioids for Chronic Non-Cancer Pain in Primary Care in Catalonia: Opicat-Padris-Project

et al. 2022

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“…Over the clinical concentration range, buprenorphine, tramadol, and oliceridine are reported to show improved tolerability and reduced overdose liability as compared to morphine or oxycodone 28–30 . The reported cases of favorable safety and tolerability in terms of low tapentadol abuse, 31–33 could in part be due to its lower intrinsic efficacy similar to buprenorphine, oliceridine, and tramadol. At the cellular level, opioid‐decreased tolerability has been associated with increased β‐arrestin recruitment 34 .…”

Section: Discussionmentioning

confidence: 99%

Tapentadol shows lower intrinsic efficacy at µ receptor than morphine and oxycodone

Manandhar

Connor

Santiago

2022

Pharmacology Res & Perspec

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Opioids have been a vital component of pain relief in acute and severe pain despite the concerns of life-threatening adverse effects. Their use in chronic pain is limited because of the risk of development of tolerance and dependence on long-term use, as well as the potential development of hyperalgesic adaptations. 1 In addition, neuropathic pain is less responsive to opioids. One strategy for developing drugs with similar analgesic action and fewer adverse effects than the prototypical opioid morphine is to synthesize drugs with a dual mechanism of action. An example of that is tramadol which has a combined mechanism of action of µ receptor activation and inhibition of serotonin (5-HT) and norepinephrine reuptake. 2 However, there are two potential drawbacks of tramadol; firstly, the drug is a prodrug and secondly, it is a mixture of two enantiomers which differently contribute to its dual mechanisms of action. (+) Tramadol preferentially causes serotonin

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“…Clinically this appears to translate into less severe gastrointestinal effects from immediate-release acute pain therapy, 9 and lower odds of causing typical opioid adverse effects including respiratory depression and dependence. 10,11 Given its place in pain treatment is still being investigated, it remains too early to assign its advantages over ‘pure’ opioids such as morphine and oxycodone.…”

Section: Atypical Opioidsmentioning

confidence: 99%

New pharmacological perspectives and therapeutic options for opioids: Differences matter

Somogyi

Musolino

Barratt

2022

Anaesth Intensive Care

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Opioids remain the major drug class for the treatment of acute, chronic and cancer pain, but have major harmful effects such as dependence and opioid-induced ventilatory impairment. Although no new typical opioids have come onto the market in the past almost 50 years, a plethora of new innovative formulations has been developed to meet the clinical need. This review is intended to shed light on new understanding of the molecular pharmacology of opioids, which has arisen largely due to the genomic revolution, and what new drugs may become available in the coming years. Atypical opioids have and are being developed which not only target the mu opioid receptor but other targets in the pain pathway. Biased mu agonists have been developed but remain ‘unbiased’ clinically. The contribution of drugs targeting non-mu opioid receptors either alone or as heterodimers shows potential promise but remains understudied. That gene splice variants of the mu opioid receptor produce multiple receptor isoforms in different brain regions, and may change with pain chronicity and phenotype, presents new challenges but also opportunities for precision pain medicine. Finally, that opioids also have pro-inflammatory effects not aligned with mu opioid receptor binding affinity implicates a fresh understanding of their role in chronic pain, whether cancer or non-cancer. Hopefully, a new understanding of opioid analgesic drug action may lead to new drug development and better precision medicine in acute and chronic pain relief with less patient harm.

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Safety of tapentadol compared with other opioids in chronic pain treatment: network meta-analysis of randomized controlled and withdrawal trials

Cited by 16 publications

References 64 publications

Trends in the Prescription of Strong Opioids for Chronic Non-Cancer Pain in Primary Care in Catalonia: Opicat-Padris-Project

Trends in the Prescription of Strong Opioids for Chronic Non-Cancer Pain in Primary Care in Catalonia: Opicat-Padris-Project

Tapentadol shows lower intrinsic efficacy at µ receptor than morphine and oxycodone

New pharmacological perspectives and therapeutic options for opioids: Differences matter

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