Transdermal Fentanyl Usage in Working-age Patients Undergoing Cancer Treatment: Prescription Pattern Analysis Using Large Claims Data in Japan

Abstract

The number of working-age individuals undergoing cancer treatment has been increasing. In these patients, transdermal fentanyl is the preferred treatment. However, it is known to have (1) pharmacodynamic interactions with benzodiazepines and (2) fever-induced pharmacokinetic variations. The aim of this study is to clarify the frequency of co-administration of benzodiazepine and the predictors for fever among working-age patients with cancer using transdermal fentanyl. We used a large claims data source including over 3.6 million patients. Finally, 759 working-age patients aged 20 to 60 years undergoing cancer treatment, in whom transdermal fentanyl was initiated, were analyzed. The proportion of patients receiving co-administration of benzodiazepines with the first administration of transdermal fentanyl was 16.5% (n = 125). This increased to 39.3% (n = 298) within 30 days. Predictive factors for fever using patients’ baseline characteristics were male sex, gastrointestinal cancer, hematological cancer, and renal disease. To provide adequate pharmacotherapy to working-age patients undergoing cancer treatment with transdermal fentanyl, medical staff should pay attention to (1) avoid adding benzodiazepines easily and (2) monitor patients having predictors for fever to avoid fentanyl-related adverse events.

Keywords:

• opioid
• transdermal fentanyl
• benzodiazepine
• large claims data
• working-age patient with cancer

Acknowledgement

We deeply appreciate Professor Dr Masayoshi Koinuma (Teikyo Heisei University), who kindly helped to obtain large claims data from JMDC Inc.

Disclosure statement

As a potential conflict of interest, KM, TS (Showa University), and JMDC Inc. are collaborating on other projects according to the collaborative research agreement. JMDC Inc. was not involved in any discussion or decision making in this study. KM received an honorarium fee from JMDC Inc. for a presentation in another study at a domestic conference in 2021. TS received an honorarium fee from Daiichi Sankyo Co., Ltd and Meiji Seika Pharma Co., Ltd. for a presentation in another study. Department of Hospital Pharmaceutics, School of Pharmacy, Showa University received a research grant from TAIHO PHARMACEUTICAL CO., LTD. in another project.

Funding

The author(s) reported there is no funding associated with the work featured in this article.