A double-blind, randomized comparative study to investigate the morphine to hydromorphone conversion ratio in Japanese cancer patients

作者：Inoue Satoshi^*; Saito Yoji; Tsuneto Satoru; Aruga Etsuko; Ogata Takeshi; Uemori Mitsutoshi

来源：Japanese Journal of Clinical Oncology, 2018, 48(5): 442-449.

DOI：10.1093/jjco/hyy046

• hydromorphone
• morphine
• cancer pain
• opioid switching
• conversion ratio
• efficacy ratio

Objective: To confirm the morphine to hydromorphone conversion ratio for hydromorphone (DS-7113b) immediate-release tablets in cancer patients who achieved pain control with oral morphine.
Methods: This was a multicenter, active-controlled, randomized, double-blind, parallel-group, comparative study (July 2013 to December 2014) at 39 Japanese sites. Seventy-one patients (aged >20 years) who had achieved pain control with morphine 60 mg/day and 90 mg/day were randomly allocated 1:1 to hydromorphone immediate-release tablets at a dose converted at a hydromorphone: morphine ratio of 1:5 or 1:8, respectively, and treated for up to 5 days. The efficacy was evaluated as the pain control ratio.
Results: The pain control ratio in the full analysis set was 83.3% (25/30) in the conversion ratio 1: 5 group and 95.0% (38/40) in the conversion ratio 1:8 group, and both groups demonstrated highly successful pain control. The incidence of adverse events was 46.7% (14/30) in the conversion ratio 1:5 group and 58.5% (24/41) in the 1:8 group; the difference was not clinically relevant. Frequently observed adverse events (incidence >= 5%) were nausea, vomiting, diarrhea, somnolence and dyspnea.
Conclusions: A high pain control ratio was maintained by a switch at either conversion ratio, and no notable difference was observed in the incidence of adverse events. A switch from morphine to hydromorphone is effective at a dose converted at ratios of 1:5 and 1:8.

• 出版日期2018-5