Abstract：
BACKGROUND: Strong opioids are the cornerstone in the treatment of cancer-related pain.
OBJECTIVE: This study aims to compare analgesic effectiveness of different strong opioids for the treatment of cancer-related pain.
METHODS: PubMed and Embase were searched for RCTs that compared strong opioids for treatment of cancer-related pain against one another. A network meta-analysis was conducted and the related Surface Under the Cumulative RAnking (SUCRA)-based treatment ranks were calculated. Primary outcome was pain intensity (numerical rating scale (NRS)) and/or the percentage of patients with ≥50% pain reduction, after 1 and 2-4 weeks.
RESULTS: Sixteen RCTs (1813 patients) were included. Methadone showed, with a high certainty of evidence, increased ORs for treatment success at 1 week, compared with morphine, buprenorphine, fentanyl, and oxycodone, range 3.230-36.833. Methadone had the highest likelihood to be the treatment of preference (ToP) (SUCRA 0.9720). For fentanyl, ORs were lower, however significant and with high certainty. After 2-4 weeks, methadone again showed the highest likelihood for ToP, however, with moderate certainty and nonsignificant ORs. The combination of morphine/methadone, compared with morphine, buprenorphine, fentanyl, hydromorphone, methadone, and oxycodone achieved a treatment effect of mean NRS difference after 2-4 weeks between -1.100 and -1.528 and had the highest likelihood for ToP.
CONCLUSIONS: The results suggest that methadone possibly deserves further promotion as first-line treatment for the treatment of cancer-related pain.
OBJECTIVE: This study aims to compare analgesic effectiveness of different strong opioids for the treatment of cancer-related pain.
METHODS: PubMed and Embase were searched for RCTs that compared strong opioids for treatment of cancer-related pain against one another. A network meta-analysis was conducted and the related Surface Under the Cumulative RAnking (SUCRA)-based treatment ranks were calculated. Primary outcome was pain intensity (numerical rating scale (NRS)) and/or the percentage of patients with ≥50% pain reduction, after 1 and 2-4 weeks.
RESULTS: Sixteen RCTs (1813 patients) were included. Methadone showed, with a high certainty of evidence, increased ORs for treatment success at 1 week, compared with morphine, buprenorphine, fentanyl, and oxycodone, range 3.230-36.833. Methadone had the highest likelihood to be the treatment of preference (ToP) (SUCRA 0.9720). For fentanyl, ORs were lower, however significant and with high certainty. After 2-4 weeks, methadone again showed the highest likelihood for ToP, however, with moderate certainty and nonsignificant ORs. The combination of morphine/methadone, compared with morphine, buprenorphine, fentanyl, hydromorphone, methadone, and oxycodone achieved a treatment effect of mean NRS difference after 2-4 weeks between -1.100 and -1.528 and had the highest likelihood for ToP.
CONCLUSIONS: The results suggest that methadone possibly deserves further promotion as first-line treatment for the treatment of cancer-related pain.
摘要：
背景：强阿片类药物是治疗癌症相关疼痛的基石。
目的：本研究旨在比较不同强阿片类药物治疗癌症相关疼痛的镇痛效果。
方法：搜索PubMed和Embase的RCT，这些RCT比较了强阿片类药物治疗癌症相关疼痛的效果。进行了网络荟萃分析，并计算了基于累积腐蚀（SUCRA）的治疗等级下的相关表面。主要结果是疼痛强度（数字评定量表（NRS））和/或疼痛减轻≥50％的患者百分比，1和2-4周后。
结果：共纳入16个RCTs（1813例）。美沙酮显示,有很高的证据确定性，在1周时治疗成功的OR增加，与吗啡相比，丁丙诺啡,芬太尼,和羟考酮,范围3.230-36.833。美沙酮成为优先治疗（ToP）的可能性最高（SUCRA0.9720）。对于芬太尼，OR较低，无论多么重要，而且具有很高的确定性。2-4周后,美沙酮再次显示出最高的可能性，然而,具有中等的确定性和不显著的OR。吗啡/美沙酮的组合，与吗啡相比，丁丙诺啡,芬太尼,氢吗啡酮,美沙酮,和羟考酮在2-4周后在-1.100和-1.528之间实现了平均NRS差异的治疗效果，并且具有最高的ToP可能性。
结论：结果表明，美沙酮作为癌症相关疼痛的一线治疗药物可能值得进一步推广。
目的：本研究旨在比较不同强阿片类药物治疗癌症相关疼痛的镇痛效果。
方法：搜索PubMed和Embase的RCT，这些RCT比较了强阿片类药物治疗癌症相关疼痛的效果。进行了网络荟萃分析，并计算了基于累积腐蚀（SUCRA）的治疗等级下的相关表面。主要结果是疼痛强度（数字评定量表（NRS））和/或疼痛减轻≥50％的患者百分比，1和2-4周后。
结果：共纳入16个RCTs（1813例）。美沙酮显示,有很高的证据确定性，在1周时治疗成功的OR增加，与吗啡相比，丁丙诺啡,芬太尼,和羟考酮,范围3.230-36.833。美沙酮成为优先治疗（ToP）的可能性最高（SUCRA0.9720）。对于芬太尼，OR较低，无论多么重要，而且具有很高的确定性。2-4周后,美沙酮再次显示出最高的可能性，然而,具有中等的确定性和不显著的OR。吗啡/美沙酮的组合，与吗啡相比，丁丙诺啡,芬太尼,氢吗啡酮,美沙酮,和羟考酮在2-4周后在-1.100和-1.528之间实现了平均NRS差异的治疗效果，并且具有最高的ToP可能性。
结论：结果表明，美沙酮作为癌症相关疼痛的一线治疗药物可能值得进一步推广。
