The use of Instanyl® in the treatment of breakthrough pain in cancer patients: a 3-month observational, prospective, cohort study

Abstract

PurposeInstanyl® (intranasal fentanyl spray) is a novel treatment for breakthrough pain (BTP) in cancer patients. It has shown a rapid onset of pain relief in clinical trials. This study examines the use of Instanyl® in real-life settings.MethodsA 3-month observational, prospective, cohort study of cancer patients with BTP receiving Instanyl® (50, 100, or 200 μg) under routine clinical practice. Data were collected at three time points corresponding with routine clinic visits – baseline, Week 4, and Week 13. Primary outcomes: success of titration and maintenance dose after titration. Secondary outcomes: change in maintenance dose of Instanyl® and level of background pain medication; Brief Pain Inventory—Short Form (BPI-SF) and Patient Treatment Satisfaction Scale (PTSS) scores; adverse drug reactions (ADRs).ResultsTitration with Instanyl® was successful in 84.5 % of 309 patients; most patients were titrated at the lowest dose (50 μg). The majority showed no change in maintenance dose, with little change in the level of background pain medication. BPI-SF and PTSS scores significantly improved from baseline to Week 4. The main reason for terminating Instanyl® was death, as expected due to the underlying disease; incidence of ADRs was low and no fatal ADRs were reported.ConclusionsIn a real-life group of cancer patients with disease progression, Instanyl® was titrated successfully at doses <200 μg in the majority of patients, requiring only one dose, with no further change in maintenance dose. Pain severity, impact of pain on daily life, and treatment satisfaction significantly improved with Instanyl® treatment. No unexpected ADRs occurred.

Intranasal Opioid Administration in Rhesus Monkeys: PET Imaging and Antinociception

“…Relief from acute, unpredictable, and highly distressing pain events, such as breakthrough cancer pain, has been improved with IN formulations of fentanyl (Karlsen et al, 2014;Kongsgaard ABBREVIATIONS: CFN, carfentanil; DVR, distribution volume ratio; IM, intramuscular, intramuscularly; IN, intranasal, intranasally; IV, intravenous, intravenously; MPE, maximum percent effect; NLX, naloxone; PET, positron emission tomography; PK, pharmacokinetics; RO, receptor occupancy; VOI, volumes-of-interest.…”

Long-term efficacy and tolerability of intranasal fentanyl in the treatment of breakthrough cancer pain

“…Other than death, discontinuation occurred for lack of efficacy or other reasons. The treatment improved patients' satisfaction and brief pain inventory from baseline to the fourth week [45].…”

Transmucosal Immediate-Release Fentanyl for Breakthrough Cancer Pain: Opportunities and Challenges for Use in Palliative Care

“…48 In a noninterventional, 3month observational study, Patient Treatment Satisfaction Scale scores reported a mean (SD) 36.8% (57.9%; n = 37; P < .001) increase from baseline to week 4 of intranasal fentanyl treatment. 49 In another study, 77.4% favored intranasal fentanyl compared with 22.6% of patients favoring oral transmucosal fentanyl citrate (P < .001). 47 Regarding ease of use, 90.1% of patients rated easy/very easy to administer intranasal medication compared with 39.8% of patients for oral transmucosal fentanyl citrate.…”

“…45,[47][48][49]78 Common adverse events are drowsiness, nausea, vomiting, and nasal pruritus. 45,[47][48][49]78 Severe and serious adverse events have been reported, which include dysgeusia, skin pain, and nasal ulcer.…”

“…45,[47][48][49]78 Common adverse events are drowsiness, nausea, vomiting, and nasal pruritus. 45,[47][48][49]78 Severe and serious adverse events have been reported, which include dysgeusia, skin pain, and nasal ulcer. 45,47,49 Common adverse events for fentanyl pectin nasal spray (Lazanda) are drowsiness, nausea, vomiting, and constipation, with the majority of these symptoms mild to moderate in severity.…”