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, 禹正杨, 朱肖奇, 等.芬太尼透皮贴剂治疗癌症疼痛的临床观察.中国肿瘤临床, 2002, 29(11):67-68.
11.	姜斌, 王梅, 王雅杰.芬太尼透皮贴剂与口服吗啡用于癌痛病人的比较.中国肿瘤临床与康复, 2002, 9(3):121-122.
12.	金炳文, 周彩存, 张捷, 等.芬太尼透皮贴剂治疗肺癌癌痛疗效分析.临床肺科杂志, 2002, 7(4):38-39.
13.	金学军, 马磊, 刘城林.芬太尼透皮贴剂与美施康定在中重度癌痛治疗中的疗效比较.中国肿瘤临床, 2002, 29(11):69-70.
14.	李蓉, 赵贵军, 沈华, 等.硫酸吗啡控释片及芬太尼透皮贴治疗癌痛的临床观察.中国综合临床, 2002, 18(5):89-90.
15.	余晓春.多瑞吉透皮贴治疗中重度癌痛的效果.江西医学院学报, 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.多瑞吉与美菲康控制癌症疼痛63例临床观察.南通医学院学报, 2003, 23(2):200-202.
18.	雷炜, 刘希光, 梁军.芬太尼透皮贴剂治疗癌痛67例的临床观察.临床肿瘤学杂志, 2003, 8(2):136-137.
19.	卢光兆.多瑞吉治疗晚期癌痛的疗效观察.国际医药卫生导报, 2003, 9(20):35-36.
20.	易基群, 蔡燕燕, 李宇清, 等.硫酸吗啡控释片与芬太尼透皮贴剂控制晚期癌症患者疼痛的比较.现代临床医学生物工程学杂志, 2003, 9(4):332-333.
21.	孟丽辉.芬太尼透皮贴剂治疗中重度癌痛的临床观察.中华医药杂志, 2004, 4(5):425-426.
22.	曲雁红.芬太尼透皮贴剂与吗啡治疗癌痛比较.锦州医学院学报, 2004, 25(1):80.
23.	沈隽, 杜利力, 张国强, 等.芬太尼透皮贴剂治疗晚期癌痛的效果.齐鲁医学杂志, 2004, 19(6):511-512, 514.
24.	吴家虹, 刘惠君, 吴岩.芬太尼透皮贴剂治疗晚期癌症疼痛的疗效评价.中国医学理论与实践, 2004, 14(8):1132-1133.
25.	杨莉, 王亚非.芬太尼贴剂与硫酸吗啡控释片治疗癌痛临床观察.现代肿瘤医学, 2004, 12(6):563-565.
26.	张建文.芬太尼透皮贴剂控制癌性疼痛疗效观察.临床荟萃, 2004, 19(2):101-102.
27.	张双捷, 刘宝瑞, 钱晓萍.芬太尼透皮贴剂与美施康定控制中重度癌痛临床疗效比较.东南大学学报(医学版), 2004, 23(5):317-319.
28.	曹云开, 张勇.芬太尼透皮贴剂与吗啡控释片治疗癌痛的临床观察.临床药物治疗杂志, 2005, 3(1):50-52.
29.	汤从容, 李文峰.多瑞吉与美施康定在晚期癌痛治疗中的药物经济学分析.肿瘤防治杂志, 2005, 12(6):479-480.
30.	汪旭, 佟仲生, 李淑芬, 等.芬太尼透皮贴剂与硫酸吗啡控释片治疗中重度慢性癌痛疗效及不良反应临床观察.天津医科大学学报, 2005, 11(4):586-589.
31.	董海鹰, 陈公琰, 李晓莉.多瑞吉与美施康定控制晚期癌痛70例的临床观察.中国医师杂志, 2006, 8(10):1430-1431.
32.	邹冰心, 黄作平, 谢强, 等.多瑞吉治疗中晚期癌症疼痛的临床疗效与生活质量分析.肿瘤防治研究, 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.芬太尼透皮贴剂与硫酸吗啡控释片治疗癌痛疗效观察.临床医药实践杂志, 2008, 17(9):755-756.
35.	何朗, 侯梅.缓释芬太尼透皮贴剂对比控释盐酸吗啡在癌痛治疗中的临床研究.华西医学, 2008, 23(2):308-309.
36.	李骏白, 林弼靖.芬太尼透皮贴剂控制晚期癌痛临床观察.江西医药, 2008, 43(6):569-571.
37.	吴斌, 赵树芳.芬太尼透皮贴剂治疗原发性肝癌癌痛疗效分析.医学理论与实践, 2008, 21(6):667-668.
38.	赵月霞, 黄丽娟.芬太尼透皮贴剂与口服吗啡控释片治疗老年中重度癌痛疗效比较.临床和实验医学杂志, 2008, 7(12):31-32.
39.	王霞, 茹鲜·乌斯曼, 帕提古丽·阿尔西丁, 等.芬太尼透皮帖剂及口服吗啡缓释片在中、重度癌性疼痛患者中应用的临床研究.新疆医科大学学报, 2010, 33(10):1248-1250, 1253.
40.	牛丽娟, 李涛, 孙惠民, 等.芬太尼透皮贴剂与吗啡控释片治疗高龄癌痛患者疗效的比较.临床麻醉学杂志, 2011, 27(10):984-985.
41.	秦玉琳.芬太尼透皮贴剂治疗中重度癌痛疗效观察.药物流行病学杂志, 2011, 20(8):397-399.
42.	阮玫.吗啡控释片与芬太尼透皮贴剂治疗癌痛的疗效分析.中国医药导报, 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.	杨琼, 陈邓林, 毕卓菲, 等.国内芬太尼透皮贴剂与口服吗啡控释片治疗中重度癌痛临床随机对照试验的Meta分析.临床肿瘤学杂志, 2008, 02):109-114.
45.	郭静波, 魏丽萍, 王玉梅.芬太尼透皮贴剂与口服吗啡控释片治疗国人中重度癌痛临床效果的Meta分析.中国卫生统计, 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, 禹正杨, 朱肖奇, 等.芬太尼透皮贴剂治疗癌症疼痛的临床观察.中国肿瘤临床, 2002, 29(11):67-68.
11. 姜斌, 王梅, 王雅杰.芬太尼透皮贴剂与口服吗啡用于癌痛病人的比较.中国肿瘤临床与康复, 2002, 9(3):121-122.
12. 金炳文, 周彩存, 张捷, 等.芬太尼透皮贴剂治疗肺癌癌痛疗效分析.临床肺科杂志, 2002, 7(4):38-39.
13. 金学军, 马磊, 刘城林.芬太尼透皮贴剂与美施康定在中重度癌痛治疗中的疗效比较.中国肿瘤临床, 2002, 29(11):69-70.
14. 李蓉, 赵贵军, 沈华, 等.硫酸吗啡控释片及芬太尼透皮贴治疗癌痛的临床观察.中国综合临床, 2002, 18(5):89-90.
15. 余晓春.多瑞吉透皮贴治疗中重度癌痛的效果.江西医学院学报, 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.多瑞吉与美菲康控制癌症疼痛63例临床观察.南通医学院学报, 2003, 23(2):200-202.
18. 雷炜, 刘希光, 梁军.芬太尼透皮贴剂治疗癌痛67例的临床观察.临床肿瘤学杂志, 2003, 8(2):136-137.
19. 卢光兆.多瑞吉治疗晚期癌痛的疗效观察.国际医药卫生导报, 2003, 9(20):35-36.
20. 易基群, 蔡燕燕, 李宇清, 等.硫酸吗啡控释片与芬太尼透皮贴剂控制晚期癌症患者疼痛的比较.现代临床医学生物工程学杂志, 2003, 9(4):332-333.
21. 孟丽辉.芬太尼透皮贴剂治疗中重度癌痛的临床观察.中华医药杂志, 2004, 4(5):425-426.
22. 曲雁红.芬太尼透皮贴剂与吗啡治疗癌痛比较.锦州医学院学报, 2004, 25(1):80.
23. 沈隽, 杜利力, 张国强, 等.芬太尼透皮贴剂治疗晚期癌痛的效果.齐鲁医学杂志, 2004, 19(6):511-512, 514.
24. 吴家虹, 刘惠君, 吴岩.芬太尼透皮贴剂治疗晚期癌症疼痛的疗效评价.中国医学理论与实践, 2004, 14(8):1132-1133.
25. 杨莉, 王亚非.芬太尼贴剂与硫酸吗啡控释片治疗癌痛临床观察.现代肿瘤医学, 2004, 12(6):563-565.
26. 张建文.芬太尼透皮贴剂控制癌性疼痛疗效观察.临床荟萃, 2004, 19(2):101-102.
27. 张双捷, 刘宝瑞, 钱晓萍.芬太尼透皮贴剂与美施康定控制中重度癌痛临床疗效比较.东南大学学报(医学版), 2004, 23(5):317-319.
28. 曹云开, 张勇.芬太尼透皮贴剂与吗啡控释片治疗癌痛的临床观察.临床药物治疗杂志, 2005, 3(1):50-52.
29. 汤从容, 李文峰.多瑞吉与美施康定在晚期癌痛治疗中的药物经济学分析.肿瘤防治杂志, 2005, 12(6):479-480.
30. 汪旭, 佟仲生, 李淑芬, 等.芬太尼透皮贴剂与硫酸吗啡控释片治疗中重度慢性癌痛疗效及不良反应临床观察.天津医科大学学报, 2005, 11(4):586-589.
31. 董海鹰, 陈公琰, 李晓莉.多瑞吉与美施康定控制晚期癌痛70例的临床观察.中国医师杂志, 2006, 8(10):1430-1431.
32. 邹冰心, 黄作平, 谢强, 等.多瑞吉治疗中晚期癌症疼痛的临床疗效与生活质量分析.肿瘤防治研究, 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.芬太尼透皮贴剂与硫酸吗啡控释片治疗癌痛疗效观察.临床医药实践杂志, 2008, 17(9):755-756.
35. 何朗, 侯梅.缓释芬太尼透皮贴剂对比控释盐酸吗啡在癌痛治疗中的临床研究.华西医学, 2008, 23(2):308-309.
36. 李骏白, 林弼靖.芬太尼透皮贴剂控制晚期癌痛临床观察.江西医药, 2008, 43(6):569-571.
37. 吴斌, 赵树芳.芬太尼透皮贴剂治疗原发性肝癌癌痛疗效分析.医学理论与实践, 2008, 21(6):667-668.
38. 赵月霞, 黄丽娟.芬太尼透皮贴剂与口服吗啡控释片治疗老年中重度癌痛疗效比较.临床和实验医学杂志, 2008, 7(12):31-32.
39. 王霞, 茹鲜·乌斯曼, 帕提古丽·阿尔西丁, 等.芬太尼透皮帖剂及口服吗啡缓释片在中、重度癌性疼痛患者中应用的临床研究.新疆医科大学学报, 2010, 33(10):1248-1250, 1253.
40. 牛丽娟, 李涛, 孙惠民, 等.芬太尼透皮贴剂与吗啡控释片治疗高龄癌痛患者疗效的比较.临床麻醉学杂志, 2011, 27(10):984-985.
41. 秦玉琳.芬太尼透皮贴剂治疗中重度癌痛疗效观察.药物流行病学杂志, 2011, 20(8):397-399.
42. 阮玫.吗啡控释片与芬太尼透皮贴剂治疗癌痛的疗效分析.中国医药导报, 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. 杨琼, 陈邓林, 毕卓菲, 等.国内芬太尼透皮贴剂与口服吗啡控释片治疗中重度癌痛临床随机对照试验的Meta分析.临床肿瘤学杂志, 2008, 02):109-114.
45. 郭静波, 魏丽萍, 王玉梅.芬太尼透皮贴剂与口服吗啡控释片治疗国人中重度癌痛临床效果的Meta分析.中国卫生统计, 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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