Intranasal fentanyl superior to oral form for breakthrough cancer pain

BERLIN (Reuters Health) - Intranasal fentanyl spray (INFS) provides effective relief of breakthrough cancer pain more quickly than oral transmucosal fentanyl citrate (OTFC), according to data released here at the 2009 ECCO 15 - ESMO 34 European Multidisciplinary Congress.

Patients also reported that INFS was easier to use.

Dr. Sebastiano Mercadante, a palliative care specialist at La Maddalena Hospital in Palermo, Italy, and colleagues randomized 139 patients to treatment with INFS (titrated to doses of 50, 100, or 200 micrograms) or OTFC (in doses of 200, 400, 600, 800, 1200 or 1600 micrograms).

Study participants had at least three episodes of weekly breakthrough cancer pain but no more than four daily episodes. All patients were on a stable chronic opioid regimen for background pain.

The primary efficacy measure was the time to onset of "meaningful pain relief" - a patient-determined measure that was recorded using a stopwatch. The clock was started with the first administration of INFS or the start of OTFC administration.

Results showed that the median time to onset of "meaningful" pain relief was 11 minutes for INFS and 16 minutes for OTFC.

The percent of patients experiencing a faster onset of meaningful pain relief with INFS was 65.7% versus a significantly lower 50% with OTFC.

More than twice as many patients found INFS easy/very easy to administer compared with OTFC (90.1% versus 39.8%).

Overall, 77.4% of patients said they preferred the spray formulation while 22.6% favored the oral form.

In addition to accelerating the onset of "meaningful" pain relief, the spray formulation bypasses the oral route and may thus be more acceptable in patients with xerostomia-related disorders, which are common in cancer patients, Dr. Mercadante said.

As many as 95% of patients with cancer pain experience breakthrough pain, Dr. Mercadante said. Of these, two-thirds experience inadequate pain control.

.

Copyright © 2009 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.