羟考酮缓控释片治疗中重度癌痛的系统评价

A systematic review of oxycodone controlled release tablets in the treatment of patients with moderate and severe cancer pain

目的:系统评价羟考酮缓控释片治疗中重度癌痛的有效性及安全性。方法:计算机检索Medline、EMBASE、Pubmed、Cochrane library、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、万方数字化期刊全文库(Wanfang),纳入羟考酮缓控释片与吗啡缓控释片比较治疗中重度癌痛的随机对照试验(RCT),对纳入研究进行方法学偏倚风险评价,对结果数据进行Meta分析。结果:共纳入9项RCT,合计828例患者。Meta分析结果显示:(1)在总体疼痛控制率方面,羟考酮缓控释片显示出优于吗啡缓控释片的疗效,差异有统计学意义[RR=1.09,95%CI(1.01,1.18),P=0.02];(2)在1 h疼痛控制率方面,仅有的3例试验表明羟考酮有一定优势,差异有统计学意义[RR=2.90,95%CI(1.86,4.52),P<0.000 01];(3)在不良反应方面,羟考酮便秘的发生率(23.3%)明显低于吗啡(39.2%),差异有统计学意义[RR=0.44,95%CI(0.31,0.64),P<0.000 1],在其他不良反应方面的比较未见统计学意义的差异。结论:羟考酮缓控释片对于中重度癌痛的疗效优于吗啡缓控释片,且便秘的发生率较少。期待后续高质量研究进一步探索。

OBJECTIVE To evaluate the effectiveness and safety of oxycodone controlled release tablets in the treatment of patients with moderate and severe cancer pain.METHODS Databases of Medline,EMBASE,Pubmed,Cochrane library,CNKI,VIP and Wanfang were searched,randomized controlled trials（RCT）of oxycodone compared with morphine in the treatment of patients with moderate and severe cancer were included.Bias risks of included RCTs were evaluated and homogeneity studies were Meta-analyzed.RESULTS 9 studies were gathered,Meta-analysis results indicated that the efficacy of oxycodone was superior to morphine,there was significant difference between two groups[RR=1.09,95%CI（1.01,1.18）,P=0.02].Meanwhile oxycodone could promptly produce analgesic effect,there was significant difference between two groups[RR=2.90,95%CI（1.86,4.52,P〈0.000 01].Compared with morphine,constipation occurred significantly less frequently with the use of oxycodone[RR=0.44,95%CI（0.31,0.64）,P〈0.000 1],there was no significant difference in the other ADRs.CONCLUSION Based on evidence recently,oxycodone controlled release tablets in the treatment of patients with moderate and severe cancer pain is more effective than morphine sustained release tablets and causes less constipation.High quality studies are expected.