Efficacy and safety of an extended-release oxycodone (Remoxy®) formulation in patients with moderate to severe osteoarthritic pain
DOI:
https://doi.org/10.5055/jom.2011.0062Keywords:
chronic pain, oxycodone extended release, osteoarthritis, RemoxyAbstract
Objective: To evaluate the efficacy and safety of an encapsulated, highly viscous formulation of extended-release oxycodone designed to resist common physical manipulation and chemical challenges (Remoxy®; King Pharmaceuticals, Inc., Bristol, TN, which was acquired by Pfizer Inc. in March 2011).
Design: An enriched enrollment randomized withdrawal trial design was used whereby patients entered a double-blind, multicenter, placebo-controlled trial after completing an open-label titration phase.
Setting: Sixty-one US clinics.
Patients: All patients (40-75 years) had experienced moderate to severe chronic osteoarthritic pain in the hip or knee for3 months.
Interventions: During 2 weeks of open-label treatment (N ≥ 558), patients were titrated from Remoxy 5 mg twice daily (bid) to 20 mg bid. Patients who tolerated the drug were randomly assigned to Remoxy or placebo bid for 12 weeks. Dose titration was permitted during weeks 1-4 (range, 10-80 mg/d) and fixed thereafter.
Main outcome measures: The area under the curve (AUC) for change in pain intensity (PI) scores from prerandomization to the end of the 12-week period was the primary endpoint. Patient assessment of quality of analgesia, global assessment of study medication, quality of life, and safety were also evaluated.
Results: The mean AUC for change in PI score was significantly greater for Remoxy than for placebo (p = 0.007). Patients receiving Remoxy reported significantly better scores on quality of analgesia (p = 0.004) and global assessment of study medication (p = 0.007) when compared with patients receiving placebo. Remoxy had a safety profile consistent with other opioids.
Conclusions: Remoxy significantly improved analgesia among patients with moderate to severe chronic osteoarthritic pain with an adverse event profile similar to other opioids.
References
Hardt J, Jacobsen C, Goldberg J, et al.: Prevalence of chronic pain in a representative sample in the United States. Pain Med. 2008; 9(7): 803-812.
Lawrence RC, Felson DT, Helmick CG, et al.: Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008; 58(1): 26-35.
Zhang W, Nuki G, Moskowitz RW, et al.: OARSI recommendations for the management of hip and knee osteoarthritis: Part 3: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage. 2010; 18(4): 476-499.
Caldwell JR, Hale ME, Boyd RE, et al.: Treatment of osteoarthritis pain with controlled release oxycodone or fixed combination oxycodone plus acetaminophen added to nonsteroidal antiinflammatory drugs: A double blind, randomized, multicenter, placebo controlled trial. J Rheumatol. 1999; 26(4): 862-869.
Portenoy RK, Farrar JT, Backonja MM, et al.: Long-term use of controlled-release oxycodone for noncancer pain: Results of a 3-year registry study. Clin J Pain. 2007; 23(4): 287-299.
Markenson JA, Croft J, Zhang PG, et al.: Treatment of persistent pain associated with osteoarthritis with controlled-release oxycodone tablets in a randomized controlled clinical trial. Clin J Pain. 2005; 21(6): 524-535.
Roth SH, Fleischmann RM, Burch FX, et al.: Around-theclock, controlled-release oxycodone therapy for osteoarthritisrelated pain: Placebo-controlled trial and long-term evaluation. Arch Intern Med. 2000; 160(6): 853-860.
Chou R, Fanciullo GJ, Fine PG, et al.: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10(2): 113-130.
American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons: Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009; 57(8): 1331-1346.
Bhamb B, Brown D, Hariharan J, et al.: Survey of select practice behaviors by primary care physicians on the use of opioids for chronic pain. Curr Med Res Opin. 2006; 22(9): 1859-1865.
Nwokeji ED, Rascati KL, Brown CM, et al.: Influences of attitudes on family physicians’ willingness to prescribe long-acting opioid analgesics for patients with chronic nonmalignant pain. Clin Ther. 2007; 29 (Suppl): 2589-2602.
Budman SH, Grimes Serrano JM, Butler SF: Can abuse deterrent formulations make a difference? Expectation and speculation. Harm Reduct J. 2009; 6: 8.
Katz NP, Adams EH, Chilcoat H, et al.: Challenges in the development of prescription opioid abuse-deterrent formulations. Clin J Pain. 2007; 23(8): 648-660.
Passik SD: Issues in long-term opioid therapy: Unmet needs, risks, and solutions. Mayo Clin Proc. 2009; 84(7): 593-601.
Aquina CT, Marques-Baptista A, Bridgeman P, et al.: OxyContin abuse and overdose. Postgrad Med. 2009; 121(2): 163-167.
Ware J Jr, Kosinski M, Keller SD: A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34(3): 220-233.
Bellamy N, Buchanan WW, Goldsmith CH, et al.: Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988; 15(12): 1833-1840.
Avouac J, Gossec L, Dougados M: Efficacy and safety of opioids for osteoarthritis: A meta-analysis of randomized controlled trials. Osteoarthritis Cartilage. 2007; 15(8): 957-965.
Zamloot M, Chao W, Kang L, et al.: Remoxy: A novel formulation of extended-release oxycodone developed using the ORADUR technology. J Appl Res. 2010; 10(3): 88-96.
Katz N: Enriched enrollment randomized withdrawal trial designs of analgesics: Focus on methodology. Clin J Pain. 2009; 25(9): 797-807.
Quessy SN: Two-stage enriched enrolment pain trials: A brief review of designs and opportunities for broader application. Pain. 2010; 148(1): 8-13.
Butera P, Klutzartiz V, Gilmore D, et al.: Long-term, 12-month, open-label phase III study of the safety of Remoxy® (oxycodone extended-release) in patients with moderate to severe chronic pain. Presented at the 25th Annual Meeting of the American Academy of Pain Medicine, Honolulu, Hawaii, 2009.
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