PMID- 21775131
OWN - NLM
STAT- MEDLINE
DCOM- 20111205
LR  - 20131121
IS  - 1879-0852 (Electronic)
IS  - 0959-8049 (Linking)
VI  - 47
IP  - 16
DP  - 2011 Nov
TI  - How to switch from morphine or oxycodone to methadone in cancer patients? a 
      randomised clinical phase II trial.
PG  - 2463-70
LID - 10.1016/j.ejca.2011.06.047 [doi]
AB  - AIM: Opioid switching is a treatment strategy in cancer patients with 
      unacceptable pain and/or adverse effects (AEs). We investigated whether patients 
      switched to methadone by the stop and go (SAG) strategy have lower pain intensity 
      (PI) than the patients switched over three days (3DS), and whether the SAG 
      strategy is as safe as the 3DS strategy. METHODS: In this prospective, open, 
      parallel-group, multicentre study, 42 cancer patients on morphine or oxycodone 
      were randomised to the SAG or 3DS switching-strategy to methadone. The methadone 
      dose was calculated using a dose-dependent ratio. PI, AEs and serious adverse 
      events (SAEs) were recorded daily for 14 days. Primary outcome was average PI day 
      3. Secondary outcomes were PI now and AEs day 3 and 14 and number of SAEs. 
      RESULTS: Twenty one patients were randomised to each group, 16 (SAG) and 19 (3DS) 
      patients received methadone. The mean preswitch morphine doses were 900 mg/day in 
      SAG and 1330 mg/day in 3DS. No differences between groups were found in mean 
      average PI day 3 (mean difference 0.5 (CI -1.2-2.2); SAG 4.1 (CI 2.3-5.9) and 3DS 
      3.6 (CI 2.9-4.3) or in PI now. The SAG group had more dropouts and three SAEs 
      (two deaths and one severe sedation). No SAEs were observed in the 3DS group. 
      CONCLUSION: The SAG patients reported a trend of more pain, had significantly 
      more dropouts and three SAEs, which indicate that the SAG strategy should not 
      replace the 3DS when switching from high doses of morphine or oxycodone to 
      methadone.
CI  - Copyright (c) 2011 Elsevier Ltd. All rights reserved.
FAU - Moksnes, K
AU  - Moksnes K
AD  - Pain and Palliation Research Group, Norwegian University of Science and 
      Technology (NTNU), Trondheim, Norway. kristin.moksnes@ntnu.no
FAU - Dale, O
AU  - Dale O
FAU - Rosland, J H
AU  - Rosland JH
FAU - Paulsen, O
AU  - Paulsen O
FAU - Klepstad, P
AU  - Klepstad P
FAU - Kaasa, S
AU  - Kaasa S
LA  - eng
PT  - Clinical Trial, Phase II
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20110719
PL  - England
TA  - Eur J Cancer
JT  - European journal of cancer (Oxford, England : 1990)
JID - 9005373
RN  - 0 (Analgesics, Opioid)
RN  - 76I7G6D29C (Morphine)
RN  - CD35PMG570 (Oxycodone)
RN  - UC6VBE7V1Z (Methadone)
SB  - IM
CIN - Eur J Cancer. 2012 Apr;48(6):944-5; author reply 946-7. PMID: 22305512
MH  - Administration, Oral
MH  - Aged
MH  - Aged, 80 and over
MH  - Analgesics, Opioid/*administration & dosage/adverse effects
MH  - Dose-Response Relationship, Drug
MH  - Drug Substitution/*methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Methadone/*administration & dosage/adverse effects
MH  - Middle Aged
MH  - Morphine/*administration & dosage/adverse effects
MH  - Neoplasms/*complications
MH  - Oxycodone/*administration & dosage/adverse effects
MH  - Pain/*drug therapy/etiology
MH  - Patient Dropouts
MH  - Prospective Studies
EDAT- 2011/07/22 06:00
MHDA- 2011/12/13 00:00
CRDT- 2011/07/22 06:00
PHST- 2011/05/03 00:00 [received]
PHST- 2011/06/20 00:00 [accepted]
PHST- 2011/07/22 06:00 [entrez]
PHST- 2011/07/22 06:00 [pubmed]
PHST- 2011/12/13 00:00 [medline]
AID - S0959-8049(11)00475-8 [pii]
AID - 10.1016/j.ejca.2011.06.047 [doi]
PST - ppublish
SO  - Eur J Cancer. 2011 Nov;47(16):2463-70. doi: 10.1016/j.ejca.2011.06.047. Epub 2011 
      Jul 19.