Efficacy and safety of titration with controlled-release oxycodone versus immediate-release morphine in patients with moderate cancer pain

Objective: To clarify the efficacy and safety of titration with controlled-release (CR) oxycodone tablets in comparison with immediate-release (IR) morphine tablets in analgesia of cancer patients with moderate pain. Methods: A total of 120 patients with moderate cancer pain admitted to the Zhejiang Cancer Hospital from January 2014 to December 2016 were enrolled and randomly assigned to receive CR oxycodone tablets (oxycodone group) or IR morphine formulation (morphine group). The medication for titration with CR oxycodone tablets were as follows: The patients in the oxycodone group were administered an initial dose of oral CR oxycodone tablets (10 mg) once 12 h, followed by symptomatic treatment on the basis of the pain intensity at 1 h after initial dose. In contrast, the patients in the morphine group were given an initial dose of IR morphine tablets (5-10 mg), and received symptomatic treatment on the basis of the pain intensity at 1 h whenever needed. Pain relief at h 24, d 3 and d 7 after titration, respectively, the improvements in quality of life (QOL), titration measurements and adverse events before and after were compared between the two groups. Results: The oxycodone group achieved a much higher rate of pain relief than the morphine group at hour 24 after titration (75% vs 56.7%, P=0.034), and a considerably lower rate of breakthrough pain (46.7% vs 100%, P<0.001); however, the rates were insignificant different at day 3 and 7 between the two groups. The total daily dose of the patients in the oxycodone group was 65.7 +/- 7.9 mg, strikingly lower than that (69.5 +/- 9.2; P=0.017) in the morphine group. Moreover, daily medications in the oxycodone group was considerably fewer than those of the morphine group (3.25 +/- 1.64 vs 4.20 +/- 1.79, P=0.003), and the time to achieve stable analgesia was strikingly earlier than the morphine group (3.42 +/- 0.56d vs 3.67 +/- 0.74d; P=0.039). After the completion of titration, the QOL, somatic function and emotional function of both groups were improved greatly as compared with those before titration (All P<0.05), but small differences in the improvements were seen between the two groups. All subtypes of adverse events were similar for the two formulations (All P>0.05). Conclusion: For patients with moderate cancer pain, the improvements in pain relief, QOL and adverse events in titration with CR oxycodone tablets were basically similar to those in immediate release with IR morphine tablets, for the exception of faster analgesic effect and simpler administration.