オキシコドン徐放錠におけるend-of-dose failureの発現因子に関する検討

抄録

World Health Organization guidelines for cancer pain relief are effective for approximately 70-90% of cancer pain patients. End-of-dose failure (EDF) is pain recurring towards the end of dosing interval for a regular scheduled opioid, potentially managed by increasing the dose or frequency of a regular scheduled opioid. In this study, in order to examine the clinical factors of a patient expressing EDF by controlled-release oxycodone (CR-Oxy), we investigated 150 cancer patients retrospectively.
The incidence of EDF in all cases is 21.3% (male/female = 25.3%/16.4%). The proportion of bone metastases (62.5% vs 43.2%, odds ratio (OR) = 2.19, P = 0.041), adjuvant analgesics (40.6% vs 13.6%, OR = 4.36, P = 0.001), non-opioid analgesics (non-steroidal anti-inflammatory drugs and acetaminophen, 93.8% vs 79.7%, OR = 3.83, P = 0.046) is higher in patients expressing EDF in comparison with patients not expressing EDF. There are no differences in total bilirubin, transaminases, and renal function. Albumin/globulin ratio tends to be higher in patients expressing EDF. EDF is highly expressed in male patients with a daily dose of 1,000 mg or more magnesium oxide used for the prevention of adverse events by opioid. These findings may be useful for predicting EDF expression. Utilization of adjuvant analgesics in nonimprovement cases is lower than improvement cases of EDF (23.5% vs 60.0%, OR = 4.88, P = 0.041). In patients with bone metastases and adjuvant analgesics, maintenance of blood concentration and choice of analgesics in consideration of the presence of intractable pain are necessary.