Mapi Values, Utrecht, The Netherlands.
Curr Med Res Opin. 2010 May;26(5):1037-45. doi: 10.1185/03007991003694340.
To compare the efficacy of intranasal fentanyl spray (INFS), oral transmucosal fentanyl citrate (OTFC), fentanyl buccal tablet (FBT) and oral morphine (OM) for the treatment of breakthrough cancer pain (BTCP).
A systematic literature review (Medline, EMBASE, BIOSIS; 1996-2007) identified six randomised controlled trials (RCTs) investigating the effects of INFS, OTFC, FBT and OM for the treatment of BTCP. The endpoint of interest was pain intensity difference (PID, reported on a 0-10 numeric rating scale [NRS]) up to 60 minutes after intake. Results of all trials were analysed simultaneously with a mixed treatment comparison (extended meta-analysis). MTC can be considered a valid method when included studies are comparable regarding effect modifying baseline patient and study characteristics.
INFS provided the greatest reduction in pain relative to placebo: PID 1.7 points (95% CrI: 1.4; 1.9) at 15 minutes, 2.0 (1.6; 2.3) at 30 minutes, 2.0 (1.5; 2.4) at 45 minutes and 1.9 (1.5; 2.4) at 60 minutes. PID for OTFC and FBT relative to placebo were 0.4 (0.0; 0.8) and 0.5 (0.3; 0.7) at 15 minutes. Both treatments provided a reduction in pain superior to placebo at other time points. INFS displayed a more than 99% probability of providing the greatest pain reduction out of all interventions compared at 15 minutes after intake. This was maintained for any measured time point before 45 minutes when compared to FBT and for any measured time point before 60 minutes when compared to OTFC. Only from 45 minutes onwards did OM show a greater pain reduction than placebo.
Based on currently available evidence, INFS is expected to provide the greatest improvement in the treatment of BTCP. Due to its slow onset to effect OM cannot be considered an efficacious treatment for BTCP.
比较鼻腔内芬太尼喷雾（INFS）、口腔黏膜芬太尼枸橼酸盐（OTFC）、芬太尼颊片剂（FBT）和口服吗啡（OM）治疗突破性癌症疼痛（BTCP）的疗效。
系统文献回顾（Medline、EMBASE、BIOSIS；1996-2007）确定了 6 项随机对照试验（RCT），研究了 INFS、OTFC、FBT 和 OM 治疗 BTCP 的效果。关注的终点是摄入后 60 分钟内的疼痛强度差异（PID，报告为 0-10 数字评分量表[NRS]）。所有试验的结果均同时进行混合治疗比较（扩展荟萃分析）。当纳入的研究在影响因素（如患者和研究特征）方面具有可比性时，MTC 可被视为一种有效的方法。
与安慰剂相比，INFS 能更显著地减轻疼痛：15 分钟时疼痛缓解 1.7 点（95%置信区间：1.4；1.9），30 分钟时 2.0 点（1.6；2.3），45 分钟时 2.0 点（1.5；2.4），60 分钟时 1.9 点（1.5；2.4）。OTFC 和 FBT 相对于安慰剂的 PID 分别为 0.4（0.0；0.8）和 0.5（0.3；0.7），在 15 分钟时。两种治疗方法在其他时间点都比安慰剂更能减轻疼痛。与摄入后 15 分钟时的其他干预措施相比，INFS 显示出超过 99%的可能性提供最大的疼痛缓解。在与 FBT 相比的 45 分钟之前的任何测量时间点，以及在与 OTFC 相比的 60 分钟之前的任何测量时间点，这一情况都得到了维持。只有从 45 分钟开始，OM 才显示出比安慰剂更大的疼痛缓解作用。
根据目前的证据，INFS 有望在治疗 BTCP 方面提供最大的改善。由于其起效缓慢，OM 不能被认为是 BTCP 的有效治疗方法。
