Transdermal Fentanyl versus Morphine for Moderate/Severe Cancer Pain: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 ZOUYuan ¹ , YANGFeng ² , ZHUYa-ping ¹

1. Department of Anesthesiology, Haiyan Hospital of Traditional Chinese Medicine of Zhejiang, Jiaxing 314300, China;
2. Third People's Hospital of Ningxia, Yinchuan 750011, China;

Corresponding?author：

Keywords：

Transdermal fentanyl; Oral morphine; Cancer pain; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140222

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the efficacy of transdermal fentanyl versus oral morphine for moderate/severe cancer pain. Methods Databases such as The Cochrane Library (Issue 1, 2014), PubMed, Web of Science, CNKI, VIP, CBM and WanFang Data were searched for randomized controlled trials (RCTs) on the efficacy of transdermal fentanyl versus oral morphine for moderate/severe cancer pain up to January 2014. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.1.0 software. Results A total of 35 RCTs involved 3 406 patients were included. The results of meta-analysis showed that, there was no significant difference in effectiveness between transdermal fentanyl and oral morphine for moderate/severe cancer pain (OR=1.00, 95%CI 0.80 to 1.27, P=0.99). Compared with oral morphine, transdermal fentanyl was better in lowering the incidences of constipation, nausea and vomiting, lethargy and urinary retention; but transdermal fentanyl increased the incidences of skin rashes and itch (P < 0.05). Conclusion Transdermal fentanyl is as effective as oral morphine in the treatment of moderate/severe cancer pain, and transdermal fentanyl causes less side effects. Due to poor quality of the included studies, the above conclusion should be verified by further conducting more high quality RCTs.

Citation： ZOUYuan, YANGFeng, ZHUYa-ping. Transdermal Fentanyl versus Morphine for Moderate/Severe Cancer Pain: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(11): 1380-1388. doi: 10.7507/1672-2531.20140222 Copy

1.	?Cleary JF. The pharmacologic management of cancer pain. J Palliat Med, 2007, 10(6):1369-1394.
2.	Wiffen PJ, Wee B, Moore RA. Oral morphine for cancer pain. Cochrane Database Syst Rev, 2013, 7:Cd003868.
3.	Cachia E, Ahmedzai SH. Transdermal opioids for cancer pain. Curr Opin Support Palliat Care, 2011, 5(1):15-19.
4.	Jeal W, Benfield P. Transdermal fentanyl. A review of its pharmacological properties and therapeutic efficacy in pain control. Drugs, 1997, 53(1):109-138.
5.	Muijsers RB, Wagstaff AJ. Transdermal fentanyl:an updated review of its pharmacological properties and therapeutic efficacy in chronic cancer pain control. Drugs, 2001, 61(15):2289-2307.
6.	Kornick CA, Santiago-Palma J, Moryl N, et al. Benefit-risk assessment of transdermal fentanyl for the treatment of chronic pain. Drug Saf, 2003, 26(13):951-973.
7.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
8.	Ahmedzai S, Brooks D. Transdermal fentanyl versus sustained-release oral morphine in cancer pain:preference, efficacy, and quality of life. The TTS-Fentanyl Comparative Trial Group. J Pain Symptom Manage, 1997, 13(5):254-261.
9.	Wong JO, Chiu GL, Tsao CJ, et al. Comparison of oral controlled-release morphine with transdermal fentanyl in terminal cancer pain. Acta Anaesthesiol Sin, 1997, 35(1):25-32.
10.	何建萍, 禹正楊, 朱肖奇, 等.芬太尼透皮貼劑治療癌癥疼痛的臨床觀察.中國腫瘤臨床, 2002, 29(11):67-68.
11.	姜斌, 王梅, 王雅杰.芬太尼透皮貼劑與口服嗎啡用于癌痛病人的比較.中國腫瘤臨床與康復, 2002, 9(3):121-122.
12.	金炳文, 周彩存, 張捷, 等.芬太尼透皮貼劑治療肺癌癌痛療效分析.臨床肺科雜志, 2002, 7(4):38-39.
13.	金學軍, 馬磊, 劉城林.芬太尼透皮貼劑與美施康定在中重度癌痛治療中的療效比較.中國腫瘤臨床, 2002, 29(11):69-70.
14.	李蓉, 趙貴軍, 沈華, 等.硫酸嗎啡控釋片及芬太尼透皮貼治療癌痛的臨床觀察.中國綜合臨床, 2002, 18(5):89-90.
15.	余曉春.多瑞吉透皮貼治療中重度癌痛的效果.江西醫學院學報, 2002, 42(2):124.
16.	van Seventer R, Smit JM, Schipper RM, et al. Comparison of TTS-fentanyl with sustained-release oral morphine in the treatment of patients not using opioids for mild-to-moderate pain. Curr Med Res Opin, 2003, 19(6):457-469.
17.	郭俊平.多瑞吉與美菲康控制癌癥疼痛63例臨床觀察.南通醫學院學報, 2003, 23(2):200-202.
18.	雷煒, 劉希光, 梁軍.芬太尼透皮貼劑治療癌痛67例的臨床觀察.臨床腫瘤學雜志, 2003, 8(2):136-137.
19.	盧光兆.多瑞吉治療晚期癌痛的療效觀察.國際醫藥衛生導報, 2003, 9(20):35-36.
20.	易基群, 蔡燕燕, 李宇清, 等.硫酸嗎啡控釋片與芬太尼透皮貼劑控制晚期癌癥患者疼痛的比較.現代臨床醫學生物工程學雜志, 2003, 9(4):332-333.
21.	孟麗輝.芬太尼透皮貼劑治療中重度癌痛的臨床觀察.中華醫藥雜志, 2004, 4(5):425-426.
22.	曲雁紅.芬太尼透皮貼劑與嗎啡治療癌痛比較.錦州醫學院學報, 2004, 25(1):80.
23.	沈雋, 杜利力, 張國強, 等.芬太尼透皮貼劑治療晚期癌痛的效果.齊魯醫學雜志, 2004, 19(6):511-512, 514.
24.	吳家虹, 劉惠君, 吳巖.芬太尼透皮貼劑治療晚期癌癥疼痛的療效評價.中國醫學理論與實踐, 2004, 14(8):1132-1133.
25.	楊莉, 王亞非.芬太尼貼劑與硫酸嗎啡控釋片治療癌痛臨床觀察.現代腫瘤醫學, 2004, 12(6):563-565.
26.	張建文.芬太尼透皮貼劑控制癌性疼痛療效觀察.臨床薈萃, 2004, 19(2):101-102.
27.	張雙捷, 劉寶瑞, 錢曉萍.芬太尼透皮貼劑與美施康定控制中重度癌痛臨床療效比較.東南大學學報(醫學版), 2004, 23(5):317-319.
28.	曹云開, 張勇.芬太尼透皮貼劑與嗎啡控釋片治療癌痛的臨床觀察.臨床藥物治療雜志, 2005, 3(1):50-52.
29.	湯從容, 李文峰.多瑞吉與美施康定在晚期癌痛治療中的藥物經濟學分析.腫瘤防治雜志, 2005, 12(6):479-480.
30.	汪旭, 佟仲生, 李淑芬, 等.芬太尼透皮貼劑與硫酸嗎啡控釋片治療中重度慢性癌痛療效及不良反應臨床觀察.天津醫科大學學報, 2005, 11(4):586-589.
31.	董海鷹, 陳公琰, 李曉莉.多瑞吉與美施康定控制晚期癌痛70例的臨床觀察.中國醫師雜志, 2006, 8(10):1430-1431.
32.	鄒冰心, 黃作平, 謝強, 等.多瑞吉治療中晚期癌癥疼痛的臨床療效與生活質量分析.腫瘤防治研究, 2007, 34(3):207-208.
33.	Ozturk T, Karadibak K, Catal D, et al. Comparison of TD-fentanyl with sustained-release morphine in the pain treatment of patients with lung cancer. Agri, 2008, 20(3):20-25.
34.	高改珍.芬太尼透皮貼劑與硫酸嗎啡控釋片治療癌痛療效觀察.臨床醫藥實踐雜志, 2008, 17(9):755-756.
35.	何朗, 侯梅.緩釋芬太尼透皮貼劑對比控釋鹽酸嗎啡在癌痛治療中的臨床研究.華西醫學, 2008, 23(2):308-309.
36.	李駿白, 林弼靖.芬太尼透皮貼劑控制晚期癌痛臨床觀察.江西醫藥, 2008, 43(6):569-571.
37.	吳斌, 趙樹芳.芬太尼透皮貼劑治療原發性肝癌癌痛療效分析.醫學理論與實踐, 2008, 21(6):667-668.
38.	趙月霞, 黃麗娟.芬太尼透皮貼劑與口服嗎啡控釋片治療老年中重度癌痛療效比較.臨床和實驗醫學雜志, 2008, 7(12):31-32.
39.	王霞, 茹鮮·烏斯曼, 帕提古麗·阿爾西丁, 等.芬太尼透皮帖劑及口服嗎啡緩釋片在中、重度癌性疼痛患者中應用的臨床研究.新疆醫科大學學報, 2010, 33(10):1248-1250, 1253.
40.	牛麗娟, 李濤, 孫惠民, 等.芬太尼透皮貼劑與嗎啡控釋片治療高齡癌痛患者療效的比較.臨床麻醉學雜志, 2011, 27(10):984-985.
41.	秦玉琳.芬太尼透皮貼劑治療中重度癌痛療效觀察.藥物流行病學雜志, 2011, 20(8):397-399.
42.	阮玫.嗎啡控釋片與芬太尼透皮貼劑治療癌痛的療效分析.中國醫藥導報, 2011, 8(20):117-119.
43.	Clark AJ, Ahmedzai SH, Allan LG, et al. Efficacy and safety of transdermal fentanyl and sustained-release oral morphine in patients with cancer and chronic non-cancer pain. Curr Med Res Opin, 2004, 20(9):1419-1428.
44.	楊瓊, 陳鄧林, 畢卓菲, 等.國內芬太尼透皮貼劑與口服嗎啡控釋片治療中重度癌痛臨床隨機對照試驗的Meta分析.臨床腫瘤學雜志, 2008, 02):109-114.
45.	郭靜波, 魏麗萍, 王玉梅.芬太尼透皮貼劑與口服嗎啡控釋片治療國人中重度癌痛臨床效果的Meta分析.中國衛生統計, 2010, 17(4):385-387.
46.	Hadley G, Derry S, Moore RA, et al. Transdermal fentanyl for cancer pain. Cochrane Database Syst Rev, 2013, 10:CD010270.
47.	Bian ZX, Shang HC. CONSORT 2010 statement:updated guidelines for reporting parallel group randomized trials. Ann Intern Med, 2011, 154(4):290-291.

1. ?Cleary JF. The pharmacologic management of cancer pain. J Palliat Med, 2007, 10(6):1369-1394.
2. Wiffen PJ, Wee B, Moore RA. Oral morphine for cancer pain. Cochrane Database Syst Rev, 2013, 7:Cd003868.
3. Cachia E, Ahmedzai SH. Transdermal opioids for cancer pain. Curr Opin Support Palliat Care, 2011, 5(1):15-19.
4. Jeal W, Benfield P. Transdermal fentanyl. A review of its pharmacological properties and therapeutic efficacy in pain control. Drugs, 1997, 53(1):109-138.
5. Muijsers RB, Wagstaff AJ. Transdermal fentanyl:an updated review of its pharmacological properties and therapeutic efficacy in chronic cancer pain control. Drugs, 2001, 61(15):2289-2307.
6. Kornick CA, Santiago-Palma J, Moryl N, et al. Benefit-risk assessment of transdermal fentanyl for the treatment of chronic pain. Drug Saf, 2003, 26(13):951-973.
7. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
8. Ahmedzai S, Brooks D. Transdermal fentanyl versus sustained-release oral morphine in cancer pain:preference, efficacy, and quality of life. The TTS-Fentanyl Comparative Trial Group. J Pain Symptom Manage, 1997, 13(5):254-261.
9. Wong JO, Chiu GL, Tsao CJ, et al. Comparison of oral controlled-release morphine with transdermal fentanyl in terminal cancer pain. Acta Anaesthesiol Sin, 1997, 35(1):25-32.
10. 何建萍, 禹正楊, 朱肖奇, 等.芬太尼透皮貼劑治療癌癥疼痛的臨床觀察.中國腫瘤臨床, 2002, 29(11):67-68.
11. 姜斌, 王梅, 王雅杰.芬太尼透皮貼劑與口服嗎啡用于癌痛病人的比較.中國腫瘤臨床與康復, 2002, 9(3):121-122.
12. 金炳文, 周彩存, 張捷, 等.芬太尼透皮貼劑治療肺癌癌痛療效分析.臨床肺科雜志, 2002, 7(4):38-39.
13. 金學軍, 馬磊, 劉城林.芬太尼透皮貼劑與美施康定在中重度癌痛治療中的療效比較.中國腫瘤臨床, 2002, 29(11):69-70.
14. 李蓉, 趙貴軍, 沈華, 等.硫酸嗎啡控釋片及芬太尼透皮貼治療癌痛的臨床觀察.中國綜合臨床, 2002, 18(5):89-90.
15. 余曉春.多瑞吉透皮貼治療中重度癌痛的效果.江西醫學院學報, 2002, 42(2):124.
16. van Seventer R, Smit JM, Schipper RM, et al. Comparison of TTS-fentanyl with sustained-release oral morphine in the treatment of patients not using opioids for mild-to-moderate pain. Curr Med Res Opin, 2003, 19(6):457-469.
17. 郭俊平.多瑞吉與美菲康控制癌癥疼痛63例臨床觀察.南通醫學院學報, 2003, 23(2):200-202.
18. 雷煒, 劉希光, 梁軍.芬太尼透皮貼劑治療癌痛67例的臨床觀察.臨床腫瘤學雜志, 2003, 8(2):136-137.
19. 盧光兆.多瑞吉治療晚期癌痛的療效觀察.國際醫藥衛生導報, 2003, 9(20):35-36.
20. 易基群, 蔡燕燕, 李宇清, 等.硫酸嗎啡控釋片與芬太尼透皮貼劑控制晚期癌癥患者疼痛的比較.現代臨床醫學生物工程學雜志, 2003, 9(4):332-333.
21. 孟麗輝.芬太尼透皮貼劑治療中重度癌痛的臨床觀察.中華醫藥雜志, 2004, 4(5):425-426.
22. 曲雁紅.芬太尼透皮貼劑與嗎啡治療癌痛比較.錦州醫學院學報, 2004, 25(1):80.
23. 沈雋, 杜利力, 張國強, 等.芬太尼透皮貼劑治療晚期癌痛的效果.齊魯醫學雜志, 2004, 19(6):511-512, 514.
24. 吳家虹, 劉惠君, 吳巖.芬太尼透皮貼劑治療晚期癌癥疼痛的療效評價.中國醫學理論與實踐, 2004, 14(8):1132-1133.
25. 楊莉, 王亞非.芬太尼貼劑與硫酸嗎啡控釋片治療癌痛臨床觀察.現代腫瘤醫學, 2004, 12(6):563-565.
26. 張建文.芬太尼透皮貼劑控制癌性疼痛療效觀察.臨床薈萃, 2004, 19(2):101-102.
27. 張雙捷, 劉寶瑞, 錢曉萍.芬太尼透皮貼劑與美施康定控制中重度癌痛臨床療效比較.東南大學學報(醫學版), 2004, 23(5):317-319.
28. 曹云開, 張勇.芬太尼透皮貼劑與嗎啡控釋片治療癌痛的臨床觀察.臨床藥物治療雜志, 2005, 3(1):50-52.
29. 湯從容, 李文峰.多瑞吉與美施康定在晚期癌痛治療中的藥物經濟學分析.腫瘤防治雜志, 2005, 12(6):479-480.
30. 汪旭, 佟仲生, 李淑芬, 等.芬太尼透皮貼劑與硫酸嗎啡控釋片治療中重度慢性癌痛療效及不良反應臨床觀察.天津醫科大學學報, 2005, 11(4):586-589.
31. 董海鷹, 陳公琰, 李曉莉.多瑞吉與美施康定控制晚期癌痛70例的臨床觀察.中國醫師雜志, 2006, 8(10):1430-1431.
32. 鄒冰心, 黃作平, 謝強, 等.多瑞吉治療中晚期癌癥疼痛的臨床療效與生活質量分析.腫瘤防治研究, 2007, 34(3):207-208.
33. Ozturk T, Karadibak K, Catal D, et al. Comparison of TD-fentanyl with sustained-release morphine in the pain treatment of patients with lung cancer. Agri, 2008, 20(3):20-25.
34. 高改珍.芬太尼透皮貼劑與硫酸嗎啡控釋片治療癌痛療效觀察.臨床醫藥實踐雜志, 2008, 17(9):755-756.
35. 何朗, 侯梅.緩釋芬太尼透皮貼劑對比控釋鹽酸嗎啡在癌痛治療中的臨床研究.華西醫學, 2008, 23(2):308-309.
36. 李駿白, 林弼靖.芬太尼透皮貼劑控制晚期癌痛臨床觀察.江西醫藥, 2008, 43(6):569-571.
37. 吳斌, 趙樹芳.芬太尼透皮貼劑治療原發性肝癌癌痛療效分析.醫學理論與實踐, 2008, 21(6):667-668.
38. 趙月霞, 黃麗娟.芬太尼透皮貼劑與口服嗎啡控釋片治療老年中重度癌痛療效比較.臨床和實驗醫學雜志, 2008, 7(12):31-32.
39. 王霞, 茹鮮·烏斯曼, 帕提古麗·阿爾西丁, 等.芬太尼透皮帖劑及口服嗎啡緩釋片在中、重度癌性疼痛患者中應用的臨床研究.新疆醫科大學學報, 2010, 33(10):1248-1250, 1253.
40. 牛麗娟, 李濤, 孫惠民, 等.芬太尼透皮貼劑與嗎啡控釋片治療高齡癌痛患者療效的比較.臨床麻醉學雜志, 2011, 27(10):984-985.
41. 秦玉琳.芬太尼透皮貼劑治療中重度癌痛療效觀察.藥物流行病學雜志, 2011, 20(8):397-399.
42. 阮玫.嗎啡控釋片與芬太尼透皮貼劑治療癌痛的療效分析.中國醫藥導報, 2011, 8(20):117-119.
43. Clark AJ, Ahmedzai SH, Allan LG, et al. Efficacy and safety of transdermal fentanyl and sustained-release oral morphine in patients with cancer and chronic non-cancer pain. Curr Med Res Opin, 2004, 20(9):1419-1428.
44. 楊瓊, 陳鄧林, 畢卓菲, 等.國內芬太尼透皮貼劑與口服嗎啡控釋片治療中重度癌痛臨床隨機對照試驗的Meta分析.臨床腫瘤學雜志, 2008, 02):109-114.
45. 郭靜波, 魏麗萍, 王玉梅.芬太尼透皮貼劑與口服嗎啡控釋片治療國人中重度癌痛臨床效果的Meta分析.中國衛生統計, 2010, 17(4):385-387.
46. Hadley G, Derry S, Moore RA, et al. Transdermal fentanyl for cancer pain. Cochrane Database Syst Rev, 2013, 10:CD010270.
47. Bian ZX, Shang HC. CONSORT 2010 statement:updated guidelines for reporting parallel group randomized trials. Ann Intern Med, 2011, 154(4):290-291.

Chinese Journal of Evidence-Based Medicine

Transdermal Fentanyl versus Morphine for Moderate/Severe Cancer Pain: A Systematic Review

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