Fondazione IRCCS Istituto Nazionale Tumori-Milano, Italy.
Palliat Med. 2011 Jul;25(5):471-7. doi: 10.1177/0269216310387962.
The aim of this systematic review is to evaluate the scientific evidence for the efficacy and side effects of hydromorphone in the management of moderate to severe cancer pain. Randomized and non-randomized clinical trials, reporting data on efficacy and/or side effects of hydromorphone, were identified. Thirteen eligible studies, involving 1208 patients, were selected. Seven studies compared hydromorphone with other opioids (five with morphine, one with oxycodone and one with fentanyl and buprenorphine) and five of them were randomized controlled trials (RCTs). Most of the studies were conducted on patients already receiving opioid treatment, often at stabilized doses, and most had methodological limitations. The RCTs comparing hydromorphone with morphine and oxycodone showed similar analgesic results, while the comparison of side effects showed minor differences, not consistent across studies. Due to clinical and methodological heterogeneity of the studies, a meta-analysis was not performed. In conclusion there is evidence to support the efficacy and tolerability of hydromorphone for moderate to severe cancer pain as an alternative to morphine and oxycodone, while there is no evidence to demonstrate its superiority or inferiority in comparison with morphine as the first choice opioid for the same indication.
本系统评价旨在评估氢吗啡酮治疗中重度癌痛的疗效和副作用的科学证据。我们检索了报道氢吗啡酮疗效和/或副作用的随机和非随机临床试验。共纳入 13 项符合条件的研究，涉及 1208 例患者。其中 7 项研究比较了氢吗啡酮与其他阿片类药物（5 项与吗啡，1 项与羟考酮，1 项与芬太尼和丁丙诺啡），其中 5 项为随机对照试验（RCT）。大多数研究是在已经接受阿片类药物治疗的患者中进行的，通常是在稳定剂量下进行的，而且大多数研究都存在方法学上的局限性。与吗啡和羟考酮比较氢吗啡酮的 RCT 显示出相似的镇痛效果，而对副作用的比较显示出不一致的差异。由于研究的临床和方法学异质性，未进行荟萃分析。总之，有证据支持氢吗啡酮治疗中重度癌痛的疗效和耐受性，可以作为吗啡和羟考酮的替代药物，而没有证据表明它在作为同一适应证的首选阿片类药物时比吗啡具有优势或劣势。
