IV PCA With or Without Continuous Dose vs Oral Opioid to Maintain Analgesia for Severe Cancer Pain After Successful Titration
Study Details
Study Description
Brief Summary
Based on the previous HMORCT09-2, the results show that IV PCA for analgesia maintenance improvements control of severe cancer pain after successful titration. Therefore, a study is planned to further explore the difference of efficacy and safety between PCA with continuous
- bolus dose versus bolus-only.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 3 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: PCA with continuous + bolus dose (1)Intravenous PCA with hydromorphone after successful titration of 24 hours;(2)PCA hydromorphone with continuous infusion where dose/h was the total equianalgesic over the previous 24h divided by 24 and bolus dosage for breakthrough pain was 10%-20% of the total equianalgesic over the previous 24h;lockout time = 10 minutes;(3)Evaluate every 24 hours and PCA parameters were adjusted according to the dose of the previous day; (4)The treatment regimen was continued for 7 days. |
Drug: Hydromorphone Hydrochloride Injection
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 every 24 hours and PCA parameters were adjusted according to the dose of the previous day.
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Experimental: PCA with bolus-only dose (1)Intravenous PCA with hydromorphone after successful titration of 24 hours; (2)PCA hydromorphone with bolus-only where dosage was 10%-20% of the total equianalgesic over the previous 24h administrated as needed;(3)Evaluate every 24 hours and PCA parameters were adjusted according to the dose of the previous day; (4)The treatment regimen was continued for 7 days. |
Drug: Hydromorphone Hydrochloride Injection
Intravenous PCA with hydromorphone after successful titration of 24 hours.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 every 24 hours and PCA parameters were adjusted according to the dose of the previous day.
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Active Comparator: Oral opioid (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)Oral sustained-released morphine where total equianalgesic over the previous 24h/2×75% every 12h/day and immediate-release morphine for breakthrough pain was 10%-20% of the total equianalgesic over the previous 24h; (3)Evaluate every 24 hours and the dose for the next day is adjusted according to the dose of the previous day;(4)The treatment regimen was continued for 7 days. |
Drug: Morphine Sulfate Sustained-release Tablets
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 day 1; 2)the total equianalgesic of the previous 24 hours/2 for day 2 ; 3)Evaluate every 24 hours and the dose for the next day is adjusted according to the dose of the previous day;4) Immediate release morphine orally = 10-20% of the total equianalgesic of the previous 24 hours;
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Outcome Measures
Primary Outcome Measures
- Mean pain score of days 1 to 3 [up to 4 days]
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. Mean pain score is a sum of average NRS of Day 1 (D 1) to Day 3 divided by 3 (the day of titration is defined as D0, the first day after titration is defined as D1, the second day after titration is defined as D2, and so on).
- Number of Breakthrough cancer Pain (BTcP) [up to 4 days]
Breakthrough cancer Pain (BTcP) is NRS > 3
Secondary Outcome Measures
- Mean pain score of days 1 to 6 [up to 7 days]
Mean pain score is a sum of average NRS of D1 to D6 divided by 6
Other Outcome Measures
- Number of patients with an average NRS pain score >3 [up to 7 days]
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.
- Number of patients with an average NRS pain score > 6 [up to 7 days]
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.
- Daily opioid dosage [up to 7 days]
Daily opioid dosage
- Satisfaction score [up to 7 days]
The satisfaction score of the patients to analgesia was evaluated by 10-point scale: 0 points for dissatisfaction, 10 points for very satisfied, the higher the score, the higher the satisfaction.
- Quality of life of patients [up to 7 days]
Chinese version of the Edmonton Symptom Assessment System.
- Number of patients who switched/discontinued therapy due to serious adverse events or lack of pain control [up to 7 days]
The number of patients who switched/discontinued therapy due to serious adverse events or lack of pain control
Eligibility Criteria
Criteria
Inclusion Criteria:
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The patients were 18-80 years old and diagnosed as malignant solid tumor by pathology;
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Patients with persistent cancer pain and NRS score ≥ 7 during previous 24 hours;
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Patients who did not receive radiotherapy, chemotherapy or targeted therapy within 7 days before randomization and trial;
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Patients or his/her caregivers who are able to fill out the questionnaire forms ;
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Ability to correctly understand and cooperate with medication guidance of doctors and nurses ;
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Without psychiatric problems;
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ECOG performance status ≤3;
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Patients who did not receive the trial drug within 14 days before the trial;
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The subjects voluntarily signed the informed consent.
Exclusion Criteria:
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The pain is confirmed not due to cancer;
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Patients with severe post-operative pain;
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Patients with paralytic ileus;
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Patients with brain metastasis;
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Patients hypersensitive to opioids;
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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;
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Patients who cannot take drugs orally;
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Patients with an incoercible nausea or vomiting;
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Those who have received monoamine oxidase inhibitor (MAOI) within two weeks before randomization;
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Patients who are pregnant or in lactation, or who plan to be pregnant within one month after the trial;
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Alcoholic patients;
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Patients with other conditions or reasons causing the patients unable to complete the clinical trial.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | China, Fujian | Fuzhou | Fujian | China | 350014 |
Sponsors and Collaborators
- Fujian Cancer Hospital
Investigators
- Principal Investigator: Rong bo Lin, MD, Fujian Cancer Hospital,Department of Gastrointestinal Medical Oncology
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- SYLT021/HMORCT09-3