Jandhyala Ravi, Fullarton John
Cephalon UK, Welwyn Garden City, UK.
BMJ Support Palliat Care. 2012 Jun;2(2):156-62. doi: 10.1136/bmjspcare-2011-000139.
To compare the efficacy of fentanyl effervescent buccal tablet (FBT), sublingual oral transmucosal fentanyl citrate (ODT) and compressed lozenge oral transmucosal fentanyl citrate (OTFC) for the treatment of breakthrough cancer pain (BTcP).
Randomised, controlled trials of FBT, ODT and OTFC in the treatment of BTcP were identified via a systematic literature review. Pain intensity difference (PID) data were extracted from all eligible studies for all recorded time points. A mixed treatment comparison of these data was undertaken with placebo as the indirect comparator. The primary outcome was improvement in PID during the first 60 min after dosing (15-60 min).
There was a 66% probability of FBT producing a greater improvement in PID during the first 60 min after dosing than ODT (mean improvement in PID 0.54) and a 68% probability versus OTFC (mean PID 0.48). ODT and OTFC produced a similar level of pain relief during the 60-min time period (53% probability; mean PID 0.10, in favour of ODT). When data for OTFC versus morphine sulphate immediate release (MSIR) were included, it was found that FBT and ODT both produced better PID scores over the 60-min time period than MSIR (FBT: 68% probability, mean PID 0.75; ODT: 57% probability, mean PID 0.35). The improved outcome for FBT and ODT over MSIR was evident from 15 min after dosing.
FBT may have some efficacy advantages over ODT and OTFC and all oral fentanyl preparations appear superior to MSIR in the treatment of BTcP.
比较芬太尼泡腾颊片（FBT）、舌下口腔黏膜芬太尼枸橼酸盐（ODT）和压缩含片口腔黏膜芬太尼枸橼酸盐（OTFC）治疗癌性爆发痛（BTcP）的疗效。
通过系统文献回顾确定FBT、ODT和OTFC治疗BTcP的随机对照试验。从所有符合条件的研究中提取所有记录时间点的疼痛强度差异（PID）数据。以安慰剂作为间接对照对这些数据进行混合治疗比较。主要结局是给药后前60分钟（15 - 60分钟）PID的改善情况。
FBT在给药后前60分钟使PID改善程度大于ODT（PID平均改善0.54）的概率为66%，大于OTFC（平均PID 0.48）的概率为68%。在60分钟时间段内，ODT和OTFC产生的疼痛缓解水平相似（概率53%；平均PID 0.10，倾向于ODT）。当纳入OTFC与硫酸吗啡速释片（MSIR）对比的数据时，发现FBT和ODT在60分钟时间段内的PID评分均优于MSIR（FBT：概率68%，平均PID 0.75；ODT：概率57%，平均PID 0.35）。给药15分钟后，FBT和ODT相对于MSIR的改善结果就很明显。
FBT在治疗BTcP方面可能比ODT和OTFC具有一些疗效优势，并且所有口服芬太尼制剂在治疗BTcP方面似乎均优于MSIR。
