Safety and efficacy of transdermal buprenorphine for the relief of cancer pain

Abstract

Purpose: This study aimed to synthesize the available evidence on the efficacy and safety of transdermal (TD) buprenorphine. Methods: We searched studies in electronic databases. Randomized controlled trials (RCTs) assessing the efficacy of TD buprenorphine comparing with placebo or other comparator drug in relieving cancer pain were included. The primary end points are patient-reported pain intensity and pain relief. For dichotomous data, the summary relative risk (RR) and its 95 % confidence interval (CI) were derived using random-effect model in view of heterogeneity testing. Results: Eight clinical trials (n = 909) were included in the analysis. Only a few studies reported the same outcome in similar way, which created difficulty in the pooling of outcome data. Two studies (n = 288) assessed 'responders' and showed a significant difference between TD buprenorphine and placebo in all three doses of TD buprenorphine, 35.5, 52.5, or 70 μg/h (RR 1.74, 95 % CI 1.31-2.32; I 2 0 %); the numbers-needed-to-treat was 5.8 (3.9-11). Two studies (n = 331) showed a comparable requirement for rescue SL buprenorphine between TD buprenorphine and placebo (RR 1.25, 95 % CI 0.84-1.88; I 2 0 %). The preferred outcome measure '50 % pain relief' was not reported in any included studies. On the basis of summary quality, further research is likely to have an important impact on our confidence in the estimate. Conclusion: Transdermal buprenorphine has an increasing role for the relief of cancer pain. Further research in this field is needed. Multicentre studies in this field using a common protocol and strict supervision will be more practicable. © 2013 Springer-Verlag Berlin Heidelberg.