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Transdermal buprenorphine plus oral paracetamol vs an oral codeine-paracetamol combination for osteoarthritis of hip and/or knee: a randomised trial.
Osteoarthritis Cartilage. 2011 Aug; 19(8):930-8.OC

Abstract

OBJECTIVE

Low-dose transdermal opioids offer a new therapeutic option for osteoarthritis (OA). This study compared symptom relief obtained with buprenorphine patches plus oral paracetamol with that obtained with an oral codeine-paracetamol combination tablet (co-codamol) in older adults with OA.

METHOD

Two hundred and twenty people (aged ≥60 years) with OA hip and/or knee pain were randomised to treatment with 7-day buprenorphine patches plus oral paracetamol (5-25 μg/h buprenorphine patches plus 1000 mg oral paracetamol q.i.d. (4 times daily); n=110) or co-codamol tablets (two 8/500-two 30/500 mg tablets q.i.d.; n=110). They entered a titration period of up to 10 weeks, during which their dose of study medication was adjusted until they reached optimum pain control. Patients who achieved optimum pain control entered a 12-week assessment period. The primary outcome was average daily pain scores recorded using the box scale-11 (BS-11) pain scale.

RESULTS

Both treatments significantly reduced patient pain scores. The estimated treatment difference [95% confidence interval (CI)] was -0.02 (-0.64, 0.60) for the per protocol (PP) population. The results were similar for the full analysis population. Patients receiving 7-day buprenorphine patches plus oral paracetamol needed significantly less escape medication (ibuprofen) than those receiving co-codamol tablets (P=0.002; PP population). Less than 10% of patients in the 7-day buprenorphine patches plus oral paracetamol group were receiving the highest dose level at the end of the study, compared with 34% in the co-codamol group. Withdrawal rates were high in both groups. The incidence of adverse events (AEs) was comparable between the groups (86.4% of patients in the 7-day buprenorphine patches plus oral paracetamol group; 81.7% in the co-codamol group). Six serious AEs were reported in three patients (2.7%) in the 7-day buprenorphine patches plus oral paracetamol group and one (0.9%) in the co-codamol group.

CONCLUSIONS

7-day buprenorphine patches plus oral paracetamol were non-inferior to co-codamol tablets with respect to analgesic efficacy in older adults with OA pain in the hip/knee.

Authors+Show Affiliations

Section of Musculoskeletal Disease, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK. p.conaghan@leeds.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21477658

Citation

Conaghan, P G., et al. "Transdermal Buprenorphine Plus Oral Paracetamol Vs an Oral Codeine-paracetamol Combination for Osteoarthritis of Hip And/or Knee: a Randomised Trial." Osteoarthritis and Cartilage, vol. 19, no. 8, 2011, pp. 930-8.
Conaghan PG, O'Brien CM, Wilson M, et al. Transdermal buprenorphine plus oral paracetamol vs an oral codeine-paracetamol combination for osteoarthritis of hip and/or knee: a randomised trial. Osteoarthr Cartil. 2011;19(8):930-8.
Conaghan, P. G., O'Brien, C. M., Wilson, M., & Schofield, J. P. (2011). Transdermal buprenorphine plus oral paracetamol vs an oral codeine-paracetamol combination for osteoarthritis of hip and/or knee: a randomised trial. Osteoarthritis and Cartilage, 19(8), 930-8. https://doi.org/10.1016/j.joca.2011.03.011
Conaghan PG, et al. Transdermal Buprenorphine Plus Oral Paracetamol Vs an Oral Codeine-paracetamol Combination for Osteoarthritis of Hip And/or Knee: a Randomised Trial. Osteoarthr Cartil. 2011;19(8):930-8. PubMed PMID: 21477658.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transdermal buprenorphine plus oral paracetamol vs an oral codeine-paracetamol combination for osteoarthritis of hip and/or knee: a randomised trial. AU - Conaghan,P G, AU - O'Brien,C M, AU - Wilson,M, AU - Schofield,J P, Y1 - 2011/04/06/ PY - 2010/09/21/received PY - 2011/02/17/revised PY - 2011/03/28/accepted PY - 2011/4/12/entrez PY - 2011/4/12/pubmed PY - 2012/1/6/medline SP - 930 EP - 8 JF - Osteoarthritis and cartilage JO - Osteoarthr. Cartil. VL - 19 IS - 8 N2 - OBJECTIVE: Low-dose transdermal opioids offer a new therapeutic option for osteoarthritis (OA). This study compared symptom relief obtained with buprenorphine patches plus oral paracetamol with that obtained with an oral codeine-paracetamol combination tablet (co-codamol) in older adults with OA. METHOD: Two hundred and twenty people (aged ≥60 years) with OA hip and/or knee pain were randomised to treatment with 7-day buprenorphine patches plus oral paracetamol (5-25 μg/h buprenorphine patches plus 1000 mg oral paracetamol q.i.d. (4 times daily); n=110) or co-codamol tablets (two 8/500-two 30/500 mg tablets q.i.d.; n=110). They entered a titration period of up to 10 weeks, during which their dose of study medication was adjusted until they reached optimum pain control. Patients who achieved optimum pain control entered a 12-week assessment period. The primary outcome was average daily pain scores recorded using the box scale-11 (BS-11) pain scale. RESULTS: Both treatments significantly reduced patient pain scores. The estimated treatment difference [95% confidence interval (CI)] was -0.02 (-0.64, 0.60) for the per protocol (PP) population. The results were similar for the full analysis population. Patients receiving 7-day buprenorphine patches plus oral paracetamol needed significantly less escape medication (ibuprofen) than those receiving co-codamol tablets (P=0.002; PP population). Less than 10% of patients in the 7-day buprenorphine patches plus oral paracetamol group were receiving the highest dose level at the end of the study, compared with 34% in the co-codamol group. Withdrawal rates were high in both groups. The incidence of adverse events (AEs) was comparable between the groups (86.4% of patients in the 7-day buprenorphine patches plus oral paracetamol group; 81.7% in the co-codamol group). Six serious AEs were reported in three patients (2.7%) in the 7-day buprenorphine patches plus oral paracetamol group and one (0.9%) in the co-codamol group. CONCLUSIONS: 7-day buprenorphine patches plus oral paracetamol were non-inferior to co-codamol tablets with respect to analgesic efficacy in older adults with OA pain in the hip/knee. SN - 1522-9653 UR - https://www.unboundmedicine.com/medline/citation/21477658/Transdermal_buprenorphine_plus_oral_paracetamol_vs_an_oral_codeine_paracetamol_combination_for_osteoarthritis_of_hip_and/or_knee:_a_randomised_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1063-4584(11)00107-5 DB - PRIME DP - Unbound Medicine ER -