title: Comparative clinical effects of hydromorphone and morphine: a meta-analysis.
abstract: We have conducted a meta-analysis of the clinical effects of morphine and hydromorphone to compare their benefit in analgesia. Embase and Medline were searched with an end-date of June 2009 for randomized, controlled trials or observational studies that addressed comparative analgesic and side-effects or particular side-effects. Two researchers independently identified included studies and extracted the data. Estimates of opioid effects were combined by using a random-effects model. Meta-analysis of eight studies suggested that hydromorphone (494 patients) provides slightly better (P=0.012) clinical analgesia than morphine (510 patients). The effect-size was small (Cohen's d=0.266) and disappeared when one study was removed, although the advantage of hydromorphone was more evident in studies of better quality (Jadad's rating). Side-effects were similar, for example, nausea (P=0.383, nine studies, 456 patients receiving hydromorphone and 460 morphine); vomiting (P=0.306, six studies, 246 patients receiving hydromorphone and 239 morphine); or itching (P=0.249, eight studies, 405 patients receiving hydromorphone, 410 morphine). This suggests some advantage of hydromorphone over morphine for analgesia. Additional potential clinical pharmacological advantages with regard to side-effects, such as safety in renal failure or during acute analgesia titration, are based on limited evidence and require substantiation by further studies.
authors.affiliation: Pharmazentrum frankfurt/ZAFES, Institute of Clinical Pharmacology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Felden
authors.forename: C
authors.initials: C
authors.lastname: Walter
authors.forename: S
authors.initials: S
authors.lastname: Harder
authors.forename: R-D
authors.initials: RD
authors.lastname: Treede
authors.forename: H
authors.initials: H
authors.lastname: Kayser
authors.forename: D
authors.initials: D
authors.lastname: Drover
authors.forename: G
authors.initials: G
authors.lastname: Geisslinger
authors.forename: J
authors.initials: J
authors.lastname: Lötsch
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D006801:Humans; D004091:Hydromorphone / Q000009:adverse effects / Q000627:therapeutic use*; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D004091:Hydromorphone