Transdermal buprenorphine and fentanyl patches in cancer pain: a network systematic review

Abstract

Treatment of cancer pain is generally based on the three-step World Health Organization (WHO) pain relief ladder, which utilizes a sequential approach with drugs of increasing potency. Goals of pain management include optimization of analgesia, optimization of activities of daily living, minimization of adverse effects, and avoidance of aberrant drug taking. In addition, it is recommended that analgesic regimens are individualized and simplified to help ensure patient compliance and should provide the least invasive, easiest, and safest route of opioid administration to ensure adequate analgesia. Buprenorphine and fentanyl are two opioids available for the relief of moderate-to-severe cancer pain. Available clinical data regarding the transdermal (TD) formulations of these opioids and the extent to which they fulfill the recommendations mentioned earlier are systematically reviewed, with the aim of providing additional information for oncologists and pain specialists regarding their comparative use. Due to lack of studies directly comparing TD buprenorphine with TD fentanyl, data comparing these with other step-3 opioids are also evaluated in a network fashion.

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Keywords:

• analgesia
• cancer pain management
• chronic pain/drug therapy
• drug evaluation
• pain management
• patch analgesics

Acknowledgments

Financial support for the writing of this review was provided by Mundipharma Pte Ltd.

Disclosure

Dr Jin Seok Ahn reports personal fees from BMS, Eisai, Janssen, Roche, Menarini, and Boehringer Ingelheim outside the submitted work. Dr Setsuro Ogawa reports personal fees from Mundipharma K.K. outside the submitted work. Dr Tony O’Brien reports personal fees from Archimedes, AstraZeneca, Grunenthal, Janssen-Cilag, Mundipharma, and Teva outside the submitted work. Dr Andrea Bothwell reports personal fees from In Vivo Communications (Asia) Pte Ltd, the medical communications agency commissioned by Mundipharma Pte Ltd for this project, during the conduct of the study; personal fees from various pharmaceutical companies, outside the submitted work. Dr Hanlim Moon reports personal fees from Mundipharma Pte Ltd during the conduct of the study. Dr Yacine Hadjiat reports personal fees from Mundipharma Pte Ltd during the conduct of the study. Dr Abhijith Ganapathi reports personal fees from Mundipharma Pte Ltd during the conduct of the study. Dr Johnson Lin, Dr Chen Yuan, and Dr Brian HC Le report no conflicts of interest in this work.