Transdermal Fentanyl in Patients with Cachexia-A Scoping Review

Area of Science:

• Pharmacology
• Oncology
• Pain Management

Background:

• Cachexia is common in various diseases, often requiring potent analgesics.
• Transdermal fentanyl (TDF) is used for chronic pain, but its use in cachectic patients is not well-established.
• Limited and conflicting data exist on TDF efficacy and safety in cachectic individuals.

Purpose of the Study:

• To conduct a scoping review of evidence on transdermal fentanyl (TDF) in cachectic patients.
• To assess the analgesic efficacy and tolerability of TDF in this specific patient group.
• To explore how cachexia characteristics influence fentanyl pharmacokinetics (PK).

Main Methods:

• Comprehensive literature search of PubMed, Embase, and Web of Science databases up to March 2024.
• Included observational and clinical studies of cachectic patients with moderate-to-severe pain treated with TDF.
• Excluded preclinical studies, case reports, and conference abstracts; assessed study quality using NIH tools.

Main Results:

• Nine studies were included, with quality ranging from moderate to high.
• Four studies indicated negative impacts of cachexia on TDF efficacy, requiring higher doses and showing lower plasma concentrations.
• Three studies found minimal impact, while two suggested potential benefits of cachexia on TDF outcomes.

Conclusions:

• The current evidence regarding transdermal fentanyl (TDF) use in cachectic patients is insufficient.
• Definitive recommendations for TDF prescribing in cachectic patients cannot be made at this time.
• Further research is needed to clarify TDF efficacy, safety, and pharmacokinetic variability in cachexia.