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Efficacy of Controlled-Release Oxycodone

Central Oregon Cancer Treatment Center, Bend, OR

To the Editor: In the article by Bruera et al,¹ I believe that Table 2 is inconsistent with the Results section in the Abstract. I have the impression that the data for controlled-release oxycodone and controlled-release morphine have been reversed in either the Table 2 or the Abstract.

In addition, the authors on two occasions claim that the efficacy of controlled-release oxycodone is "at least equal" to that of controlled-release morphine. I believe that the data support a claim of equality, but the phrase "at least equal" suggests to me that the authors are claiming that the oxycodone regimen is equal to or greater than that of the morphine regimen. If they are claiming this, I do not believe it is justified by the data. I ask that the authors clarify their meaning.

REFERENCES

1. Bruera E, Belzile M, Pituskin E, et al: Randomized, double-blind, cross-over trial comparing safety and efficacy of oral controlled-release oxycodone with controlled-release morphine in patients with cancer pain. J Clin Oncol 16:3222-3229, 1998[Abstract]

Grey Nuns Community Hospital & Health Centre, Edmonton, Alberta, Canada

In Reply: We reviewed our database and we apologize for the transposition of the visual analog scale (VAS) and categorical scale (CAT) scores in our Abstract.¹ The correct mean overall VAS and CAT scores are 24 mm and 1.3 for controlled-release oxycodone and 23 mm and 1.2 for controlled-release morphine, respectively. Table 2 and the statistical analysis are correct. There were no significant differences in the VAS and CAT scores between the two drugs.

Comerford expresses concern that the term "at least equal" could be interpreted as suggesting that oxycodone was "equal to or greater than" morphine. Our results with slow-release oxycodone are similar to our previously reported results with slow-release oral morphine,² slow-release oral hydromorphone,³ and slow-release morphine suppositories.⁴ These studies, as well as most of the available literature, strongly suggest that slow-release opioids have no significant clinical advantages with regard to analgesic efficacy or side-effect profile. The main advantage of all these agents is increased patient comfort, particularly when patients require long-term therapy at home.

REFERENCES

1. Bruera E, Belzile M, Pituskin E, et al: Randomized, double-blind, cross-over trial comparing safety and efficacy of oral controlled-release oxycodone with controlled-release morphine in patients with cancer pain. J Clin Oncol 16:3222-3229, 1998

2. Finn JW, Walsh TD, MacDonald N, et al: Placebo-blinded study of morphine sulfate sustained-release tables and immediate-release morphoine sulfate solution in outpatients with chronic pain due to advanced cancer. J Clin Oncol 11:967-972, 1993[Abstract/Free Full Text]

3. Bruera E, Sloan P, Mount B, et al: A randomized, double-blind, double-dummy, crossover trial comparing the safety and efficacy of oral sustained-release hydromorphone with immediate-release hydromorphone in patients with cancer pain. J Clin Oncol 14:1713-1717, 1996[Abstract/Free Full Text]

4. Bruera E, Fainsinger RL, Spachynski K, et al: Steady-state pharmacokinetic evaluation of a novel, controlled release morphine suppository and subcutaneous morphine in cancer pain. J Clin Pharmacol 35:666-672, 1995[Abstract]

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Comerford, T. Articles by Bruera, E. Search for Related Content PubMed PubMed Citation Articles by Comerford, T. Articles by Bruera, E. Social Bookmarking                            What's this?