Pan-European, open-label dose titration study of fentanyl buccal tablet in patients with breakthrough cancer pain

1. U.R. Kleeberg¹,
2. A. Davies^2,*,
3. J. Jarosz³,
4. S. Mercadante⁴,
5. P. Poulain⁵,
6. T. O'Brien⁶,
7. H. Schneid⁷ and
8. H.G. Kress⁸

Article first published online: 2 SEP 2014

DOI: 10.1002/ejp.577

© 2014 European Pain Federation - EFIC^®

Issue

European Journal of Pain

Abstract

Background

Fentanyl buccal tablet (FBT), a rapid onset opioid used to treat breakthrough cancer pain, must be titrated to an effective dose that provides adequate analgesia and minimizes undesirable events. This open-label, randomized study compared the percentage of patients achieving an effective dose of FBT when starting titration at 100 or 200 μg.

Methods

Opioid-tolerant patients with chronic cancer-related pain who experienced up to four breakthrough pain episodes daily were randomized to a starting dose of 100 or 200 μg for the titration period. The dose was increased until an effective dose (100, 200, 400, 600 or 800 μg) providing adequate analgesia with acceptable adverse events was achieved. Patients achieving an effective dose entered a treatment period during which they treated up to eight breakthrough pain episodes with their effective dose.

Results

A total of 442 patients from 135 sites in seven European countries were screened. Non-inferiority was established with the percentage of patients achieving an effective dose starting titration at 200 μg (81.4%) compared with the 100-μg (75.2%) starting dose. The most common effective doses of FBT were 200 μg (39.6%) and 400 μg (26.9%). No new safety concerns were identified with use of FBT at doses up to 800 μg per episode.

Conclusions

This study involving a real clinical practice setting showed a similar percentage of patients safely achieving an effective dose by titration starting with 100 versus 200 μg of FBT.