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Carson S, Thakurta S, Low A, et al. Drug Class Review: Long-Acting Opioid Analgesics: Final Update 6 Report [Internet]. Portland (OR): Oregon Health & Science University; 2011 Jul.

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Drug Class Review: Long-Acting Opioid Analgesics

Drug Class Review: Long-Acting Opioid Analgesics: Final Update 6 Report [Internet].

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Summary

Strength of Evidence

The results of this review are summarized in Table 8, below, and Appendix E summarizes the strength of the evidence for each key question. Although we identified 10 head-to-head trials comparing 2 or more long-acting opioids, the evidence was insufficient to determine if there are differences among the drugs. Eight trials found no significant difference in pain relief or function between long-acting opioids. The 2 trials which found a significant difference (1 trial of transdermal fentanyl vs. oral long-acting morphine and 1 trial of extended-release morphine vs. sustained-release oxycodone) were both open-label, rated poor quality, and were inconsistent with higher-quality trials evaluating the same comparison that found no significant differences.

Table 8. Summary of evidence.

Table 8

Summary of evidence.

There was also insufficient evidence to determine whether long-acting opioids as a class are more effective or associated with fewer harms than short-acting opioids. Seven fair-quality trials directly compared a long-acting opioid to a short-acting opioid. These trials were highly heterogeneous in terms of study design, patient populations, interventions, and outcomes assessed. There was fair -quality evidence from 3 more homogeneous trials to suggest that long-acting oxycodone and short-acting oxycodone are equally effective for pain control in adult patients with chronic noncancer pain.

There was insufficient evidence to assess comparative effectiveness or harms in subgroups.

Limitations

This report was limited by a lack of good-quality direct evidence. Most included studies were relatively small, of short duration, and had important methodologic flaws. We were unable to conduct quantitative meta-analyses due to diversity among the trials in populations, outcome measures, and study designs. Methodological limitations of this review within the defined scope included the exclusion of studies published in languages other than English and lack of a specific search for unpublished studies.

Applicability

The trials generally provided inadequate information to accurately assess applicability or showed evidence of having highly selected populations. Most trials did not report numbers of patients screened or eligible for entry and some did not specify exclusion criteria. When exclusion criteria were specified, patients at risk for drug or substance abuse were typically excluded from trial participation.

Copyright © 2011 by Oregon Health & Science University.
Bookshelf ID: NBK62331

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