Mercadante S et al. - In a trial to compare the analgesic and adverse effects, doses, as well as cost of opioid drugs, supportive drug therapy and other analgesic drugs in pts treated with oral sustained-release morphine, transdermal fentanyl, and oral methadone, it was found that methadone was significantly less expensive, but required more changes, up and down, of the doses, suggesting that dose titration requires major clinical expertise Methods
108 cancer pts, no longer responsive to opioids for moderate pain, were selected to randomly receive initial daily doses of 60 mg of oral sustained-release morphine, 15 mg of oral methadone, or 0.6 mg of transdermal fentanyl
Oral morphine was used as breakthrough pain medication during opioid titration
Opioid doses, pain intensity, adverse effects, symptomatic drugs, were recorded at week intervals for 4 weeks
Costs of opioid therapy, supportive drugs, and other analgesic drugs were also evaluated
Results
70 pts completed the 4-week study period
5, 5, and 4 pts, treated with oral morphine, transdermal fentanyl, and oral methadone, respectively, required opioid switching
No differences in pain and symptom intensity were observed
Opioid escalation index was significantly lower in pts receiving methadone, although requiring up and down changes in doses
At the doses used, methadone was significantly less expensive, while the use and costs of supportive drugs and other analgesics were similar in the 3 groups
No relevant differences in adverse effects were observed among the groups during either the titration phase and chronic treatment
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