Table 3GRADE profile summary comparing immediate-release morphine with sustained-release morphine for first-line treatment of pain

Quality assessmentSummary of findings
No of patientsEffectQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsSustained-release morphineImmediate-release morphineRelative (95% CI)Absolute
Pain
21aRandomised trialsSeriousbNo serious inconsistencySeriouscNo serious imprecisionNone883d729dNot pooled.
No differences reported
LOW
Side effects/adverse events
18eRandomised trialsSeriousbNo serious inconsistencySeriouscNo serious imprecisionNone693d593dNot pooled.
Some differences reported within some of the studies
LOW
(Health-related) quality of life
2fRandomised trialsSeriousgNo serious inconsistencySerioushSeriousgNone71j67jNot pooled.
No differences reported
VERY LOW
a

Published as full text: Arkinstall et al. (1989); Christrup et al. (1999); Cundiff et al. (1989); Deschamps et al. (1992); Finn et al. (1993); Gillette et al. (1997); Hanks et al. (1987); Klepstad et al. (2003); Knudsen et al. (1985); Panich and Charnvej (1993); Thirlwell et al. (1989); Ventafridda et al. (1989); Walsh et al. (1992). Published as abstracts Dalton et al. (1989); Deng et al. (1997); Levy et al. (1993); MacDonald et al. (1987); Poulain et al. (1990); Ranchere et al. (1991); Walsh (1985); Xu et al. (1995).

b

N = 8 of the studies were only in abstract form and could not therefore be fully evaluated. The quality of the studies reported in full varied (e.g., unclear methods of allocation concealment and randomisation, Intention-to-treat analysis not always performed).

c

Not all first-line treatment.

d

The majority of the included studies were of cross-over design, which means that patients were counted in both treatment groups.

e

Arkinstall et al. (1989); Christrup et al. (1999); Dalton et al. (1989); Deschamps et al. (1992); Finn et al. (1993); Gillette et al. (1997); Hanks et al. (1987); Klepstad et al. (2003); Knudsen et al. (1985); Levy et al. (1993); MacDonald et al. (1987); Panich and Charnvej (1993); Poulain et al. (1990); Ranchere et al. (1991); Thirlwell et al. (1989); Ventafridda et al. (1989); Walsh et al. (1985, 1992)

f

Klepstad et al. (2003), Ranchere et al. (1991).

g

One of the studies was in abstract form only.

h

Unclear if it was first-line treatment in all patients.

i

Small N.

j

One of the two included studies was of cross-over design, which means that patients were counted in both treatment groups.

Abbreviations: CI, confidence interval.

N = 8 of the studies were only in abstract form and could not therefore be fully evaluated. The quality of the studies reported in full varied (e.g., unclear methods of allocation concealment and randomisation, Intention-to-treat analysis not always performed).

Not all first-line treatment.

The majority of the included studies were of cross-over design, which means that patients were counted in both treatment groups.

One of the studies was in abstract form only.

Unclear if it was first-line treatment in all patients.

One of the two included studies was of cross-over design, which means that patients were counted in both treatment groups.

From: 3, Evidence review and recommendations

Cover of Opioids in Palliative Care
Opioids in Palliative Care: Safe and Effective Prescribing of Strong Opioids for Pain in Palliative Care of Adults.
NICE Clinical Guidelines, No. 140.
National Collaborating Centre for Cancer (UK).
Copyright 2012, © National Collaborating Centre for Cancer.

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