Breakthrough pain management using fentanyl buccal tablet (FBT) in combination with around-the-clock (ATC) opioids based on the efficacy and safety of FBT, and its relationship with ATC opioids: results from an open-label, multi-center study in Japanese cancer patients with detailed evaluation

Abstract

Objective: Rapid analgesic onset opioids, particularly fentanyl buccal tablet, is preferable for managing breakthrough pain. The efficacy and safety of fentanyl buccal tablet and its association with around-the-clock opioids needs to be explored with an option of dose adjustments, more closely reflecting administration in clinical practice. The aim of the study was to assess the safety and efficacy of fentanyl buccal tablet in breakthrough pain management in combination with around-the-clock opioids with the dose adjustment option, and explore the dose adjustment's influence on breakthrough pain management using detailed evaluation.

Methods: The 12-week open-label, multi-center study was conducted throughout Japan. Cancer patients aged 20 years or older, experiencing persistent pain controlled with around-the-clock opioids and breakthrough pain with supplemental medications were enrolled. Fentanyl buccal tablet and around-the-clock opioid doses could be adjusted under protocol-specified conditions. Efficacy variables were assessed at each fentanyl buccal tablet administration. Safety was assessed mainly by adverse events.

Results: All efficacy variables showed sustained analgesic effect. Nearly half the patients stayed on the same dose; most fentanyl buccal tablet administrations did not require additional supplemental medications. Dose increase of fentanyl buccal tablet and around-the-clock opioids seemed to improve breakthrough pain intensity and frequency, respectively. Fentanyl buccal tablet and around-the-clock opioid doses were not strongly associated. Treatment-related adverse events were all common with opioid treatment and did not increase over time.

Conclusions: Fentanyl buccal tablet can stably and safely manage breakthrough pain in cancer patients with independent dose adjustment based on detailed evaluation of each patient's condition. Breakthrough pain management using fentanyl buccal tablet with around-the-clock opioids at optimal doses may be an important factor in palliative care for cancer patients with breakthrough pain.

Keywords: breakthrough pain; cancer pain; fentanyl buccal tablet; pain management; rapid-onset opioids.

© The Author 2014. Published by Oxford University Press.

Figures

Figure 1.

Patient flow. aThe successful dose identified for one patient was later discontinued due to a coadministered drug criteria violation, and this patient was therefore not included in the efficacy analysis set.

Figure 2.

Efficacy evaluation items at 4-week intervals during the 12-week maintenance phasea. (a) PID30, PID60 and SPID60 at each assessment point. Assessment point difference in mean scores of PID30, PID60 and SPID60: P = 0.1199, 0.0726 and 0.0712, respectively, one-way analysis of variance (ANOVA). (b) PR30 and PR60 at each assessment point. Assessment point difference in mean scores of PR30 and PR60: P = 0.5625 and 0.3493, respectively, one-way ANOVA. (c) GMPA30 and GMPA60 at each assessment point. Assessment point difference in mean scores of GMPA30 and GMPA60: P = 0.4752 and 0.1226, respectively, one-way ANOVA. PID: pain intensity difference; SPID: summed pain intensity difference; PR: pain relief; GMPA: global medication performance assessment. aData are presented as mean ± SD.