Reddy Akhila, Tayjasanant Supakarn, Haider Ali, Heung Yvonne, Wu Jimin, Liu Diane, Yennurajalingam Sriram, Reddy Suresh, de la Cruz Maxine, Rodriguez Eden Mae, Waletich Jessica, Vidal Marieberta, Arthur Joseph, Holmes Carolyn, Tallie Kimmie, Wong Angelique, Dev Rony, Williams Janet, Bruera Eduardo
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Cancer. 2016 Jan 1;122(1):149-56. doi: 10.1002/cncr.29688. Epub 2015 Oct 9.
Transdermal fentanyl (TDF) is 1 of the most common opioids prescribed to patients with cancer. However, the accurate opioid rotation ratio (ORR) from other opioids to TDF is unknown, and various currently used methods result in wide variation of the ORR. The objective of this study was to determine the ORR of the oral morphine equivalent daily dose (MEDD) to the TDF dose when correcting for the MEDD of breakthrough opioids (the net MEDD) in cancer outpatients.
The records of 6790 consecutive patients were reviewed at the authors' supportive care center from 2010 to 2013 to identify those who underwent rotation from other opioids to TDF. Data regarding Edmonton Symptom Assessment Scale scores and MEDDs were collected for patients who returned for a follow-up visit within 5 weeks. Linear regression analysis was used to estimate the ORR between the TDF dose and the net MEDD (the MEDD before opioid rotation [OR] minus the MEDD of the breakthrough opioid used along with TDF after OR).
In total, 129 patients underwent OR from other opioids to TDF. The mean patient age was 56 years, 59% were men, and 88% had advanced cancer. Uncontrolled pain (80%) was the most frequent reason for OR. In 101 patients who underwent OR and had no worsening of pain at follow-up, the median ORR from net MEDD to TDF (in mg per day) was 0.01 (range, -0.02 to 0.04), and the correlation coefficient of the TDF dose to the net MEDD was 0.77 (P < .0001). The ORR was not significantly impacted by body mass index or serum albumin. The ORR of 0.01 suggests that an MEDD of 100 mg is equivalent to 1 mg TDF daily or approximately 40 micrograms per hour of TDF (1000 micrograms/24 hours).
The median ORR from MEDD to TDF in mg per day was 0.01. These results warrant further studies.
透皮芬太尼（TDF）是为癌症患者开具的最常用阿片类药物之一。然而，从其他阿片类药物转换为TDF的准确阿片类药物转换率（ORR）尚不清楚，并且目前使用的各种方法导致ORR差异很大。本研究的目的是确定癌症门诊患者在纠正爆发性阿片类药物的口服吗啡等效日剂量（MEDD）（净MEDD）后，口服吗啡等效日剂量与TDF剂量的ORR。
回顾了作者支持性护理中心2010年至2013年连续6790例患者的记录，以确定那些从其他阿片类药物转换为TDF的患者。收集了在5周内返回进行随访的患者的埃德蒙顿症状评估量表评分和MEDD数据。使用线性回归分析来估计TDF剂量与净MEDD（阿片类药物转换前的MEDD减去阿片类药物转换后与TDF一起使用的爆发性阿片类药物的MEDD）之间的ORR。
共有129例患者从其他阿片类药物转换为TDF。患者的平均年龄为56岁，59%为男性，88%患有晚期癌症。疼痛控制不佳（80%）是转换的最常见原因。在101例转换且随访时疼痛未加重的患者中，从净MEDD到TDF（以毫克/天为单位）的中位数ORR为0.01（范围为-0.02至0.04），TDF剂量与净MEDD的相关系数为0.77（P <.0001）。ORR不受体重指数或血清白蛋白的显著影响。ORR为0.01表明，100毫克的MEDD相当于每天1毫克TDF或约每小时40微克TDF（1000微克/24小时）。
从MEDD到TDF的以毫克/天为单位的中位数ORR为0.01。这些结果值得进一步研究。
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