Tapentadol in Cancer Patients with Neuropathic Pain: A Comparison of Methadone, Oxycodone, Fentanyl, and Hydromorphone
Tapentadol in Cancer Patients with Neuropathic Pain: A Comparison of Methadone, Oxycodone, Fentanyl, and Hydromorphone
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DOI：
10.1248/bpb.b21-00212
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发表时间：
2021-09-01
影响因子：
2
通讯作者：
Ueda, Mikiko
中科院分区：
文献类型：
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作者：
Takemura, Miho;Niki, Kazuyuki;Ueda, Mikiko
他喷他多具有μ-阿片受体刺激和去甲肾上腺素再摄取抑制特性，并且应该对神经性疼痛（NP）有效。然而，他喷他多对癌症患者NP的疗效尚不清楚。芦屋市立医院（日本兵库县）在2013年1月1日至2019年12月31日期间招募了5组日本癌症患者。NP患者接受他喷他多（n = 29）、美沙酮（n = 32）、羟考酮（n = 20）、芬太尼（n = 26）或氢吗啡酮（n = 20）治疗。主要终点是第0天和第7天之间的口头评定量表（VRS）评分差异。次要终点是每种阿片类药物的耐受性。在给予阿片类药物之前，五组之间的VRS评分无显著差异（p= 0.99）。他喷他多组第7天VRS评分的平均降低显著大于羟考酮组（p = 0.0024），并且大于美沙酮、芬太尼和氢吗啡酮组。关于安全性，他喷他多组的停药率是所有组中最低的（他喷他多vs.美沙酮vs.羟考酮vs.芬太尼vs.氢吗啡酮，分别为0.0% vs. 6.3% vs. 5.0% vs. 3.8% vs. 10.0%）。这项研究表明，他喷他多可能对NP癌症患者有效，并且在需要立即调整剂量或具有不良反应高风险的情况下是首选。然而，在没有NP特定疼痛评估量表的情况下评估疼痛强度。因此，我们认为，这是可取的，以验证我们的研究结果使用评估量表，如painDETECT问卷在未来。
Tapentadol has mu-opioid receptor stimulating and noradrenaline reuptake inhibiting properties, and should be effective for neuropathic pain (NP). However, the efficacy of tapentadol for NP in cancer patients is unclear. Ashiya Municipal Hospital (Hyogo, Japan) enrolled five groups of Japanese cancer patients between January 1, 2013, and December 31, 2019. Patients with NP were administered tapentadol (n = 29), methadone (n = 32), oxycodone (n = 20), fentanyl (n = 26), or hydromorphone (it= 20). The primary endpoint was the difference in the verbal rating scale (VRS) scores between days 0 and 7. The secondary endpoint was the tolerability of each opioid. Before administering opioids among the five groups, there was no significant difference in the VRS score (p= 0.99). The mean reduction in the VRS score on day 7 was significantly greater in the tapentadol group than in the oxycodone group (p = 0.0024) and was larger than that of the methadone, fentanyl, and hydromorphone groups. Regarding safety, the discontinuation rate in the tapentadol group was the lowest of all groups (tapentadol vs. methadone vs. oxycodone vs. fentanyl vs. hydromorphone, 0.0% vs. 6.3% vs. 5.0% vs. 3.8% vs. 10.0%, respectively). This study suggests that tapentadol could be efficacious for cancer patients with NP, and a preferred option in cases that require immediate dose adjustment or for those at high risk for adverse effects. However, the pain intensity was evaluated without pain assessment scales specific to NP. Thus, we think that it is desirable to validate our findings using assessment scales, such as the painDETECT questionnaire in future.