Comparison of the tolerability profile of controlled release oral morphine and oxycodone for cancer pain treatment. An open label randomized controlled trial

Abstract Context Oxycodone and morphine are recommended as first-choice opioids for moderate/severe cancer pain but evidence about their relative tolerability has significant methodological limitations. Objectives This study is mainly aimed at comparing the risk of developing adverse events (AEs) with controlled release oral morphine versus oxycodone; secondary aims were comparing their analgesic efficacy and testing heterogeneity in tolerability across different age and renal function subgroups. Methods An open-label multicentre RCT (EudraCT Number: 2006-003151-21) was carried out in patients with moderate/severe cancer pain. At baseline, 7 and 14 days, patients scored on 0-10 rating scales (0-10NRS) the intensity of pain and of a list of common opioid side effects. The primary endpoint was the percentage of patients reporting an AE (a worsening =2 points on any of the listed side effects); tolerability by subgroups and average follow-up pain intensity were compared through regression models. Results 187 patients were enrolled (47% of originally planned). ITT analysis (N=185, morphine 94, oxycodone 91) did not show any difference in the risk of developing AEs (risk difference -0.6%, 95%CI -11.0 % to 9.9%) nor in analgesia (0-10NRS pain intensity difference -0.28, 95%CI - 0.83 to 0.27). No evidence of heterogeneity of tolerability across age and renal function patient subgroups emerged. Conclusion This trial failed to show any difference in tolerability and analgesic efficacy of morphine and oxycodone as first-line treatment for moderate/severe cancer pain and result interpretation is difficult due to lack of power, potential bias from open-label design and concerns about assay sensitivity. These data, however, can significantly contribute to future meta-analyses comparing WHO-stepIII opioids and is relevant in designing future randomized studies.