A novel 12-week study, with three randomized, double-blind placebo-controlled periods to evaluate fentanyl buccal tablets for the relief of breakthrough pain in opioid-tolerant patients with noncancer-related chronic pain.
OBJECTIVE
To evaluate the time of onset, overall efficacy, and safety of fentanyl buccal tablet (FBT) for noncancer-related breakthrough pain (BTP) in opioid-tolerant adults over 12 weeks.


METHODS
A novel 12-week study that mimicked clinical practice with dose titration to effective dose, open-label treatment, and three randomized, double-blind, placebo-controlled, multiple-crossover periods at weeks 4, 8, and 12. For each double-blind period, study patients received nine doses (FBT = 6, placebo = 3) in a randomized sequence.


METHODS
Twenty-one study centers in the United States.


METHODS
Opioid-tolerant adults with noncancer-related chronic pain and BTP.


METHODS
The primary outcome was the sum of the pain intensity differences (PID) 5-60 minutes post dose (SPID₆₀) during the final double-blind period. Secondary outcomes included pain relief (PR), meaningful PR, and proportion of episodes with a PID of ≥33% and ≥50%.


RESULTS
Of 148 patients who entered the titration phase, 105 (71%) achieved a successful dose and 81 (55%) participated in all three assessment periods in the study. The final RCT assessment period results demonstrated continued efficacy of FBT vs placebo (P < 0.05) for SPID₆₀ (mean [SD]: 7.7 [6.2] vs 4.6 [4.7]). The average onset of PR began at 5 minutes, with meaningful PR by ≤10 minutes. The proportion of episodes with ≥33% improvement in PI was 7% with FBT vs 3% with placebo at 5 minutes and with ≥50% was 17% vs 10% at 15 minutes. All periods showed similar results. Adverse events and patient discontinuations were generally typical of clinical opioid use.


CONCLUSIONS
FBT showed continued clinically important analgesic effects and was generally well tolerated over 12 weeks of treatment.
Farrar
John T
JT
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6021, USA. jfarrar@mail.med.upenn.edu
Messina
John
J
Xie
Fang
F
Portenoy
Russell K
RK
D000278:Administration, Buccal; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease / Q000188:drug therapy*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004361:Drug Tolerance; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010919:Placebos / Q000627:therapeutic use*; D013607:Tablets / Q000627:therapeutic use; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D010919:Placebos; D013607:Tablets; D005283:Fentanyl