Transdermal buprenorphine and fentanyl patches in cancer pain: a network systematic review

Abstract

Treatment of cancer pain is generally based on the three-step World Health Organization (WHO) pain relief ladder, which utilizes a sequential approach with drugs of increasing potency. Goals of pain management include optimization of analgesia, optimization of activities of daily living, minimization of adverse effects, and avoidance of aberrant drug taking. In addition, it is recommended that analgesic regimens are individualized and simplified to help ensure patient compliance and should provide the least invasive, easiest, and safest route of opioid administration to ensure adequate analgesia. Buprenorphine and fentanyl are two opioids available for the relief of moderate-to-severe cancer pain. Available clinical data regarding the transdermal (TD) formulations of these opioids and the extent to which they fulfill the recommendations mentioned earlier are systematically reviewed, with the aim of providing additional information for oncologists and pain specialists regarding their comparative use. Due to lack of studies directly comparing TD buprenorphine with TD fentanyl, data comparing these with other step-3 opioids are also evaluated in a network fashion.

A Systematic Review in Support of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, Fourth Edition

“…Pharmacological interventions Adults and mixed samples Outcome: pain management 8 SRs 54,56,60,65,66,68,70 Eight reviews reported pain management outcomes associated with various pharmacological interventions but effects varied by study and outcome. Transdermal buprenorphine and transdermal fentanyl demonstrate equivalent analgesic efficacy in patients with cancer pain.…”

“…Eight reviews addressed pharmacological interventions for pain management and concluded there is limited evidence for metamizole in cancer pain, 70 methadone as a first-choice opioid for cancer pain, 76 levomepromazine for pain among palliative care patients, 89 paracetamol and morphine for pain in dementia patients, 65 and the use of bisphosphonates 68 or adjuvant analgesics 66 for relief of metastatic bone pain. One review concluded that transdermal buprenorphine and transdermal fentanyl demonstrate equivalent analgesic efficacy in patients with cancer pain but noted that long-term data are lacking, 56 and another review concluded that once-aday dexamethasone is the preferred corticosteroid for pain control among adult patients with glioma. 60 Three reviews reported dyspnea outcomes of pharmacological interventions; a 2016 Cochrane review concluded that there is some low-quality evidence demonstrating the ability for oral or parenteral opioids to palliate breathlessness although the number of included participants was small (change from baseline SMD À0.09; CI À0.36, 0.19; P ¼ 0.54; seven studies; post-treatment SMD À0.28; CI À0.50, À0.05; P ¼ 0.02; 11 studies).…”

Novel pharmaceutical dosage forms of analgesics

“…Do sada je iskazan veliki interes za analgetike iz grupe opioida i triptana. Od prve polovine 1990-tih godina u upotrebi su transdermalni flasteri sa fentanilom, a od 2001. godine dostupan je i buprenorfin u ovom obliku za terapiju hroničnog bola umerenog i jakog intenziteta (4,5). EMA je 2015. godine odobrila upotrebu jontoforetskog transdermalnog terapijskog sistema sa fentanilom za kontrolu umerenog i jakog postoperativnog bola kod odraslih pacijenata kada su zahtevani opioidni analgetici i primena drugih analgetika nije prihvatljiva, ali je lek povučen sa tržišta septembra 2018. godine zbog komercijalnih razloga (6).…”

“…Tabela I Karakteristike transdermalnih flastera fentanila i buprenorfina (13-15, 19, 20) 1 Tokom 72 h. 2 Transdermalni flaster sa brzinom isporuke fentanila od 12,5 μg/h, ima oznaku "12 μg/h" da bi se izbegle greške pri izdavanju u slučajevima kada se propisuje brzina isporuke fentanila od 125 μg/h (što se postiže kombinovanjem odgovarajućih transdermalnih flastera). 3 Tokom 96 h. 4 Tokom 7 dana.…”

Differences between Transdermal Fentanyl and Buprenorphine in the Elderly Hospice Patients

“…One of the possible explanations for such results might lie in a choice and formulation of the opioid used, which is rarely analyzed. Transdermal (TD) opioids are generally considered as safe and effective drugs, often preferred over oral opioids, due to their noninvasive nature, minimal interference with daily activities, and the availability in patients who are unable to swallow or have otherwise poor compliance [ 5 , 6 ].…”