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Long-term safety, tolerability, and consistency of effect of fentanyl pectin nasal spray for breakthrough cancer pain in opioid-tolerant patients

Russell K. Portenoy, MD, William Raffaeli, MD, Luis M. Torres, MD, Thomas Sitte, Akhil Chandra Deka, MD, Ileana Gonzalez Herrera, MD, Mark S. Wallace, MD


Objective: To assess the long-term safety, tolerability, and consistency of effect of fentanyl pectin nasal spray (FPNS) in patients with breakthrough cancer pain (BTCP).
Design: A multicenter, open-label study.
Patients: Patients with chronic cancer pain treated with ≥60 mg/d oral morphine or equivalent experiencing 1-4 episodes per day of BTCP.
Intervention: All patients entered into a 16-week treatment phase after undergoing a dose-titration phase with FPNS.
Main outcome measures: Safety and tolerability were assessed by adverse events (AEs) and by nasal tolerability assessments. Consistency of effect was monitored through additional rescue medication use and FPNS dose change.
Results: Four hundred three patients were included in the safety analyses. Of these, 356 patients entered the treatment phase and 110 patients completed the study. FPNS was self-administered for 42,227 episodes. During the treatment phase, 99 patients (24.6 percent) reported treatment-related AEs; most were mild or moderate and typical of opioids. Serious AEs were reported by 61 patients (15.1 percent), but only five were considered related to study drug. Of the 80 deaths that occurred during this study, one was assessed as possibly related to study drug. Nasal assessments revealed no significant local effects. No additional rescue medication was required after 94 percent of FPNS-treated episodes. More than 90 percent of patients required no increase in their initial dose of FPNS.
Conclusions: FPNS use for BTCP was associated with AEs, typical of opioids, with no evidence of nasal toxicity. A large proportion of BTCP episodes were treated with a single dose, and doses remained stable over the 4-month period.


fentanyl, breakthrough cancer pain, intranasal

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