Efficacy, safety, and tolerability of fentanyl pectin nasal spray in patients with breakthrough cancer pain

Objective: Assessment of analgesic effectiveness, safety, and tolerability of fentanyl pectin nasal spray (FPNS) in the treatment of breakthrough cancer pain (BTcP) in routine clinical practice. Methods: A prospective, open-label, noninterventional study (4-week observation period, 3 month follow-up) of opioid-tolerant adults with BTcP in 41 pain and palliative care centers in Germany. Standardized BTcP questionnaires and patient diaries were used. Evaluation was made of patient-reported outcomes with respect to "time to first effect", "time to maximum effect", BTcP relief, as well as changes in BTcP-related impairment of daily life activities, quality-of-life restrictions, and health care resource utilization. Results: A total of 235 patients were recruited of whom 220 completed all questionnaires and reported on 1,569 BTcP episodes. Patients reported a significant reduction of maximum BTcP intensity (11-stage numerical rating scale [0= no pain, 10= worst pain conceivable]) with FPNS (mean +/- standard deviation = 2.8 +/- 2.3) compared with either that reported at baseline (8.5 +/- 1.5), experienced immediately before FPNS application (7.4 +/- 1.7), or that achieved with previous BTcP medication (6.0 +/- 2.0; P<0.001 for each comparison). In 12.3% of BTcP episodes, onset of pain relief occurred = 2 minutes and in 48.4% <= 5 minutes; maximum effects were reported within 10 minutes for 37.9% and within 15 minutes for 79.4%. By the end of the study, there had been significant improvements versus baseline in BTcP-related daily life activities (28.3 +/- 16.9 vs 53.1 +/- 11.9), physical (35.9 +/- 8.4 vs 26.8 +/- 6.5), and mental quality of life (38.7 +/- 8.5 vs 29.9 +/- 7.9) (P<0.001 for each comparison vs baseline); in addition, health care resource utilization requirements directly related to BTcP were reduced by 67.5%. FPNS was well tolerated; seven patients (3.2%) experienced eight treatment-emergent adverse events of which none was serious. There were no indicators of misuse or abuse. Conclusion: FPNS provided rapid and highly effective BTcP relief in opioid-tolerant cancer patients with substantial improvements in daily functioning and quality of life. FPNS was well tolerated and associated with significant reductions in health care resource utilization and nursing assistance.