EPV007 - INTRATHECAL DRUG DELIVERY (IDD) FOR CANCER PAIN MANAGEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS (ID 110)
- Christophe Perruchoud, Switzerland
- Denis Dupoiron, France
- Christophe Perruchoud, Switzerland
- Bianca Papi, Netherlands
- Alessandra Calabrese, Switzerland
- Lisa Stearns, United States of America
- Shane Brogan, United States of America
Abstract
Introduction
Across disease states, 40 to 85% of cancer patients experience pain and more than half report moderate-to-severe pain at least monthly. Intrathecal drug delivery represents an option for patients with pain refractory to conventional medical management to improve pain treatment while reducing opioid dosages. This systematic review and pooled analyses aim to evaluate pain outcomes and systemic opioid dosage in cancer patients treated with IDD.
Methods/Materials
A systematic literature search was performed using Embase, PubMed, and Cochrane Central Register of Controlled Trials. Meta-analyses were performed using a random effects model to estimate the Mean Difference (MD) and 95 % Confidence Interval (CI) of pain scores compared to baseline. Systemic (non-intrathecal) opioid doses, expressed as oral morphine equivalents, were calculated as weighted mean, taking as weight the study sample size, and expressed as mean and standard error (SE).
Results
The review identified 29 studies (2 level 2 and 27 level 4 of the Oxford Centre for Evidence-Based Medicine) with sample size ranging from 6 to 152 patients and follow-up from 5 days to 12 months. Mean percentage of the most frequent primary cancer types was 25% lung/chest, 22% pancreatic and 21% colorectal. Of the selected studies, 13 reported pain outcome after 4-5 weeks of IDD. Compared to baseline, IDD was associated with reduced pain (MD -4.34 [95% CI, -4.93, -3.75, p<0.001] on 0-10 pain scale). Ten studies reported pain reduction after 6-12 weeks of IDD (MD -4.07 [95% CI, -4.74, -3.40, p<0.001] and 6 studies reported pain reduction after 6-12 months of treatment (MD -3.32 [95% CI, -4.60, -2.04, p<0.001]. Systemic morphine equivalents before and after IDD treatment were collected in 13 studies. Weighted mean at baseline was 572.36 (10.99) mg/day and weighted mean reduction at the last reported follow up was 357.66 (303.70) mg/day.
Discussion
Despite limited high-level trials due to difficulty running randomized controlled trials in a palliative setting, clinical studies included in these meta-analyses consistently showed that IDD is an effective treatment to manage cancer pain refractory to conventional medical management or when intolerable side effects limit the effectiveness of systemic medications. IDD should be considered as a therapeutic option in cancer pain management.
Conclusions
Meta-analyses on cancer pain management with IDD show a statistically significant and maintained (through 1 year follow-up) reduction in pain compared to baseline. Weighted means of systemic opioid dosage show in average reduction of more than 50% after IDD treatment.
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