Intravenous vs Oral Analgesia in Cancer Patients With Severe Pain After Successful Titration

NCT04243954 | Completed Phase 2 DMC

• 1 other identifier: HMORCT09-2
• Study Type: interventional
• Target: 95
• Locations: 1 country
• Sites: 1

Brief Summary

Pain is one of the most common and fear symptoms for cancer patients, which seriously affects the quality of life in cancer patients. At present, oral opioid is the most common route to administrate cancer pain. However, the patients do not satisfy the pain administration with oral opioid after successful titration in many cases, especially the cases with severe cancer pain. Patient controlled analgesia (PCA) with hydromorphone can take analgesic effect rapidly. The aim of this trial is to compare the maintenance with hydromorphone PCA intravenously or switch to Sustained-Release Morphine orally after successful titraton with hydromorphone PCA intravenously in severe cancer pain.

Conditions

Cancer Pain

Keywords

Orally; PCA intravenously; Analgesia; Severe cancer pain

Outcome Measures

Primary Outcomes (2)

• Mean pain score

  The Numerical Rating Scale (NRS, a score of 0 means no pain and 10 means the most severe) is used to assess the severity of pain. NRS of 24 hours is assessed every day. The mean pain score is a sum of NRS of day 1 (the day after successful titration of 24 hours) to day 3 divided by 3. If the NRS of the morphine orally group \>3, the NRS in the hydromorphone PCA intravenously group declines more than 30% compared to morphine orally group, which is regards a positive result.

  From day1 to day3

• Number of Breakthrough cancer Pain (BTcP) episodes

  If NRS of the morphine orally group pain score ≤3 , or if NRS in the hydromorphone PCA intravenously group declines less than 30% compared to morphine orally group, number of Breakthrough cancer Pain (BTcP) episodes in the one of both the hydromorphone PCA intravenously group declines less than 30% compared to morphine orally group, which is regards a positive result.

  From day1 to day3

Secondary Outcomes (6)

• Number of patients with an average NRS pain score> 3

  From day1 to day3

• Number of patients with an average NRS pain score> 6

  From day1 to day3

• Total dosage of opioids

  3 days

• Satisfaction score

  3 days

• Quality of life of patients

  At 24 hours

Study Arms (3)

PCA IV Hydromorphone (continuous dose = 0)

EXPERIMENTAL

1. Intravenous PCA with hydromorphone after successful titration of 24 hours. 2. The PCA setting: 1\) Continuous dose = 0; 2) Bolus dose = 10-20% of the total dosage of hydromorphone in the previous 24 hours: 3) Lockout time = 10 minutes; 4) Evaluate once every 24 hours

Drug: PCA IV Hydromorphone (continuous dose = 0)

PCA IV Hydromorphone (continuous dose ≠ 0)

EXPERIMENTAL

1. Intravenous PCA with hydromorphone after successful titration of 24 hours. 2. The PCA setting: 1\) Continuous dose (dose/hours) = the total dosage of hydromorphone in the previous 24 hours/24; 2) Bolus dose = 10-20% of the total dosage of hydromorphone in the previous 24 hours; 3) Lockout time = 10 minutes; 4) Evaluate once every 24 hours

Drug: PCA IV Hydromorphone (continuous dose ≠ 0)

Oral Morphine

ACTIVE COMPARATOR

1. Swift to sustained-release morphine orally as background dose with immediate release morphine orally for breakthrough pain after successful titration of 24 hours. 2. Administration of morphine orally 1) Sustained-release morphine orally (dose/12 hours) = the total equianalgesic of the previous 24 hours/2×75% for d1; the total equianalgesic of the previous 24 hours/2 for day 2 and day 3; 2) Immediate release morphine orally = 10-20% of the total equianalgesic of the previous 24 hours; 3) Evaluate once every 24 hours

Drug: Oral morphine

Interventions

PCA IV Hydromorphone (continuous dose ≠ 0) DRUG

Intravenous PCA with hydromorphone after successful titration of 24 hours. the PCA setting: 1) continuous dose (dose/hours) = the total dosage of hydromorphone in the previous 24 hours/24; 2) bolus dose = 10-20% of the total dosage of hydromorphone in the previous 24 hours; 3) lockout time = 10 minutes; 4) evaluate once every 24 hours

PCA IV Hydromorphone (continuous dose ≠ 0)

Oral morphine DRUG

Swift to sustained-release morphine orally as background dose with immediate release morphine orally for breakthrough pain after successful titration of 24 hours. Administration of morphine orally 1) Sustained-release morphine orally (dose/12 hours) = the total equianalgesic of the previous 24 hours/2×75% for d1; the total equianalgesic of the previous 24 hours/2 for day 2 and day 3; 2) Immediate release morphine orally = 10-20% of the total equianalgesic of the previous 24 hours; 3) Evaluate once every 24 hours

Oral Morphine

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• The patients were 18-80 years old and diagnosed as malignant tumor by pathology;
• Patients with cancer pain is NRS pain score ≥ 7 during previous 24 hours;
• Patients who will not be treated with radiotherapy within 7 days prior to randomization and during study ;
• Patients who need chemotherapy, long term administration of hormone, targeted therapy, or bisphosphonates therapy should undergo a stable anti- tumor therapy prior to randomization ;
• Patients or his/her caregivers who are able to fill out the questionnaire forms ;
• Ability to correctly understand and cooperate with medication guidance of doctors and nurses ;
• Without psychiatric problems;
• ECOG performance status ≤3;
• The subjects voluntarily signed the informed consent.

You may not qualify if:

• The pain is confirmed not due to cancer;
• Patients with severe post-operative pain;
• Patients with paralytic ileus;
• Patients with brain metastasis;
• Patients hypersensitive to opioids;
• Patients with abnormal lab results that have obvious clinical significance, such as creatine ≥ 2 fold of upper limit of normal value, alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≥ 2.5 fold of upper limit of normal value, or liver function of Child C grade;
• Patients who cannot take drugs orally;
• Patients with an incoercible nausea or vomiting;
• Those who have received monoamine oxidase inhibitor (MAOI) within two weeks before randomization;
• Patients who are pregnant or in lactation, or who plan to be pregnant within one month after the trial;
• Those with opioid addiction;
• Alcoholic patients;
• Those with cognitive dysfunction;
• Those with severe depression;
• Patients with other conditions or reasons causing the patients unable to complete the clinical trial.

Sponsors & Collaborators

• Fujian Cancer Hospital: lead

Study Sites (1)

China, Fujian

Fuzhou, Fujian, 350014, China

Location

MeSH Terms

Conditions

Cancer Pain; Agnosia

Interventions

Morphine

Condition Hierarchy (Ancestors)

Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Perceptual Disorders; Neurobehavioral Manifestations; Nervous System Diseases

Intervention Hierarchy (Ancestors)

Morphine Derivatives; Morphinans; Opiate Alkaloids; Alkaloids; Heterocyclic Compounds; Heterocyclic Compounds, Bridged-Ring; Heterocyclic Compounds, 4 or More Rings; Heterocyclic Compounds, Fused-Ring; Phenanthrenes; Polycyclic Aromatic Hydrocarbons; Polycyclic Compounds

Study Officials

• Rongbo Lin, MD

  Fujian Cancer Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 10, 2020
• First Posted: January 28, 2020
• Study Start: April 10, 2020
• Primary Completion: October 21, 2020
• Study Completion: November 21, 2020
• Last Updated: March 5, 2021

Record last verified: 2021-02

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)