Riley, J., Branford, R., Droney, J., Gretton, S., Sato, H., Kennett, A., Oyebode, C., Thick, M., Wells, A., Williams, J., Welsh, K., Ross, J. (2015) Morphine or Oxycodone for Cancer-Related Pain? A Randomized, Open-Label, Controlled Trial. JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 49 (2). pp. 161-172. ISSN 0885-3924

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Abstract

Context. There is wide interindividual variation in response to morphine for cancer-related pain; 30% of patients do not have a good therapeutic outcome. Alternative opioids such as oxycodone are increasingly being used, and opioid switching has become common clinical practice. Objectives. To compare clinical response to oral morphine vs. oral oxycodone when used as first-line or second-line (after switching) treatment in patients with cancer-related pain. Methods. In this prospective, open-label, randomized, controlled trial (ISRCTN65155201) with a selected crossover phase, patients with cancer-related pain were randomized to receive either oral morphine or oxycodone as first-line treatment. Dose was individually titrated until the patient reported adequate pain control. Patients who did not respond to the first-line opioid (either because of inadequate analgesia or unacceptable adverse effects) were switched to the alternative opioid. Results. Two hundred patients were recruited. On intention-to-treat analysis (n = 198, morphine 98, oxycodone 100), there was no significant difference between the numbers of patients responding to morphine (61/98 = 62%) or oxycodone (67/100 = 67%) when used as a first-line opioid. Similarly, there was no significant difference in subsequent response when patients were switched to either morphine (8/12 = 67%) or oxycodone (11/21 = 52%). Per-protocol analysis demonstrated a 95% response rate when both opioids were available. There was no difference in adverse reaction scores between morphine and oxycodone either in first-line responders or nonresponders. Conclusion. In this population, there was no difference between analgesic response or adverse reactions to oral morphine and oxycodone when used as a first-or second-line opioid. These data provide evidence to support opioid switching to improve outcomes. (C) 2015 Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.

Item Type:	Article
All Authors:	Riley, J., Branford, R., Droney, J., Gretton, S., Sato, H., Kennett, A., Oyebode, C., Thick, M., Wells, A., Williams, J., Welsh, K., Ross, J.
Additional Information:	ISI Document Delivery No.: AZ8PU Times Cited: 1 Cited Reference Count: 37 Riley, Julia Branford, Ruth Droney, Joanne Gretton, Sophy Sato, Hiroe Kennett, Alison Oyebode, Christina Thick, Michael Wells, Athol Williams, John Welsh, Ken Ross, Joy 1 ELSEVIER SCIENCE INC NEW YORK J PAIN SYMPTOM MANAG
Uncontrolled Keywords:	Morphine oxycodone opioid switching cancer-related pain PALLIATIVE CARE OPIOID ANALGESICS GENETIC-VARIATION ORAL MORPHINE GUIDELINES MANAGEMENT ROTATION MODERATE THERAPY SWITCH Health Care Sciences & Services Medicine, General & Internal Clinical Neurology
Research teams:	Clinical Units > Department of Palliative Medicine & Pain
Depositing User:	Users 11 not found.
Date Deposited:	19 Mar 2015 14:29
Last Modified:	19 Mar 2015 14:29
URI:	http://publications.icr.ac.uk/id/eprint/13969

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