title: Efficacy and tolerability of buccal buprenorphine in opioid-experienced patients with moderate to severe chronic low back pain: results of a phase 3, enriched enrollment, randomized withdrawal study.
abstract: A buccal film of buprenorphine (BBUP) was evaluated for safety and efficacy in a multicenter, double-blind, placebo-controlled, enriched-enrollment, randomized-withdrawal study in opioid-experienced patients (30 to ≤160 mg/d morphine sulfate equivalent) with moderate to severe chronic low back pain taking around-the-clock opioid analgesics. Patients' opioid doses were tapered to ≤30 mg morphine sulfate equivalent before open-label titration with BBUP (range, 150-900 μg every 12 hours). Patients who responded (received adequate analgesia that was generally well tolerated for 14 days) were randomized to receive buprenorphine (n = 254) or placebo (n = 257) buccal film. The primary efficacy variable was the change from baseline to week 12 of double-blind treatment in mean average daily pain-intensity scores using a rating scale of 0 (no pain) to 10 (worst pain imaginable). In the intent-to-treat population, mean pain scores were 6.7 after opioid taper and declined to 2.8 after the BBUP titration period. After randomization, mean pain scores were lower in the BBUP group than in the placebo group; the difference between groups in the mean change from baseline to week 12 was -0.98 (95% CI, -1.32 to -0.64; P < 0.001). A significantly larger percentage of patients receiving BBUP than placebo had pain reductions ≥30% and ≥50% (P < 0.001 for both). In the double-blind portion of the study, the only adverse event reported more frequently with BBUP than placebo and in ≥5% of patients was vomiting (5.5% vs 2.3%). These findings demonstrate the efficacy and tolerability of BBUP in opioid-experienced patients taking around-the-clock opioid treatment for chronic low back pain.
authors.affiliation: Arizona Research Center, Phoenix, AZ, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Gimbel
authors.affiliation: Department of Neurology, Craniofacial Pain Center, Tufts University Schools of Medicine and Dental Medicine, Boston, MA, USA.
authors.forename: Egilius L H
authors.initials: ELH
authors.lastname: Spierings
authors.affiliation: Analgesic Solutions, LLC, Natick, MA, USA.|Tufts University, Boston, MA, USA.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Katz
authors.affiliation: Endo Pharmaceuticals Inc, Malvern, PA, USA.
authors.forename: Qinfang
authors.initials: Q
authors.lastname: Xiang
authors.affiliation: Formerly of Endo Pharmaceuticals Inc, Malvern, PA, USA.
authors.forename: Evan
authors.initials: E
authors.lastname: Tzanis
authors.affiliation: BioDelivery Sciences International Inc, Raleigh, NC, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Finn
mesh_terms: D000278:Administration, Buccal; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002047:Buprenorphine / Q000008:administration & dosage*; D059350:Chronic Pain / Q000188:drug therapy; D004185:Disability Evaluation; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009294:Narcotics / Q000008:administration & dosage*; D010147:Pain Measurement; D012720:Severity of Illness Index
chemical_list: D009294:Narcotics; D002047:Buprenorphine; D009020:Morphine