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Regular, sustained-release morphine for chronic breathlessness: a multicentre, double-blind, randomised,
David Currow1,2, Sandra Louw3, Philip McCloud3
1IMPACCT, Faculty of Heath, University of Technology Sydney, Sydney, New South Wales, Australia david.currow@uts.edu.au.
Thorax
|September 28, 2019
Summary
Regular low-dose sustained-release morphine did not significantly reduce chronic breathlessness intensity in a large trial. However, patients on morphine used less rescue medication and experienced more constipation and nausea.
Area of Science:
- Cardiology
- Pulmonology
- Palliative Care
Background:
- Chronic breathlessness significantly impacts quality of life.
- Limited large-scale randomized controlled trial (RCT) data exists on morphine for chronic breathlessness.
Purpose of the Study:
- To evaluate the efficacy and safety of regular, low-dose, sustained-release (SR) morphine compared to placebo for managing chronic breathlessness.
- To assess the impact of SR morphine on breathlessness intensity, quality of life, and adverse events.
Main Methods:
- A large, parallel-arm, double-blind, multisite randomized controlled trial (RCT) involving 284 adults with chronic breathlessness.
- Participants were randomized to receive either 20 mg daily oral SR morphine with laxative or placebo with placebo laxative for 7 days.
- Primary endpoint was the change in breathlessness intensity (0-100 mm visual analogue scale) from baseline.
Main Results:
- No significant difference was found between the morphine and placebo groups for the primary endpoint of breathlessness intensity (mean difference -0.15 mm, p=0.95).
- The SR morphine group used fewer doses of immediate-release morphine as rescue medication (5.8 vs 8.7 doses, p=0.001).
- The morphine group experienced increased rates of constipation and nausea/vomiting, but no respiratory depression or obtundation occurred.
Conclusions:
- Regular low-dose SR morphine did not demonstrate superiority over placebo in reducing the intensity of chronic breathlessness.
- While not improving breathlessness scores, SR morphine reduced the need for rescue immediate-release morphine.
- The findings suggest a need for careful consideration of side effects like constipation and nausea when prescribing morphine for chronic breathlessness.
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