Fizzy tablet is best method to receive fentanyl for cancer pain

Aug 23 2012

By Sarah Guy, medwireNews Reporter

Results of a mixed treatment comparison show that fentanyl in the form of an effervescent buccal tablet (FBT) can better relieve the intensity of breakthrough cancer pain (BTcP) in the first 60 minutes after dosing compared with other fentanyl formulations.

Specifically, FBT had a higher probability of producing a greater improvement in pain intensity difference (PID) scores during this time period than sublingual oral transmucosal fentanyl citrate (ODT) and compressed lozenge oral transmucosal fentanyl citrate (OTFC), report the researchers.

Both FBT and ODT produced better PID scores over the 60-minute time period than morphine sulfate immediate release (MSIR), add Ravi Jandhyala (Cephalon UK, Welwyn Garden City) and John Fullarton (Strategen, Basingstoke, UK) in BMJ Supportive and Palliative Care.

"BTcP can have an adverse effect on the mood, function, and quality of life of affected patients," write Jandhyala and Fullerton. "The presence of BTcP may also complicate patients' overall management and result in increased healthcare costs."

The pair reviewed data from five randomized controlled trials that reported the efficacy of FBT, ODT, and/or OTFC in relieving BTcP as measured using differences in PID, where a score of 10 denotes the worst pain. All studies shared placebo as the comparator treatment.

FBT produced a superior improvement in PID (vs placebo) compared with ODT in the first hour after dosing, with a mean difference of 0.54. The same was true for FBT versus OTFC, with a mean difference of 0.48.

The researchers translate these findings into overall probabilities of greater PID improvement after 1 hour of 66% and 68% for FBT compared with ODT and OTFC, respectively.

Indeed, they note an increasing trend for FBT to produce better PID scores compared with ODT as time from dosing progressed, noting a mean difference of 0.01 after 15 minutes, 0.13 after 30 minutes, 0.54 after 45 minutes, and 0.75 after 60 minutes. A similar trend was seen for FBT versus OTFC.

One study in the analysis included data for MSIR, which performed worse in terms of PID improvement 1 hour after dosing than FBT, ODT, and OPTFC. The probabilities of achieving a superior PID in the hour after dosing with these three formulations versus MSIR were 68%, 57%, and 66%, respectively.

The apparent advantage of FBT "may relate to the mechanism of fentanyl absorption," suggest the authors. The effervescence "manipulates local pH to enhance the rate and efficiency" of absorption. However, they caution that patient preference and cost are also major determinants of treatment choice.

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