Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/21825
Title: Regular, sustained-release morphine for chronic breathlessness: a multicentre, double-blind, randomised, placebo-controlled trial.
Authors: Currow, David;Louw, Sandra;McCloud, Philip;Fazekas, Belinda;Plummer, John;McDonald, Christine F;Agar, Meera;Clark, Katherine;McCaffery, Nikki;Ekström, Magnus Pär
Affiliation: Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
IMPACCT, Faculty of Heath, University of Technology Sydney, Sydney, New South Wales, Australia
Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
University of Melbourne, Melbourne, Victoria, Australia
McCloud Consulting Group, Sydney, New South Wales, Australia
IMPACCT, Faculty of Heath, University of Technology Sydney, Sydney, New South Wales, Australia
Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, Lund, Sweden..
College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
Deakin Health Economics, Deakin University Faculty of Health, Burwood, Victoria, Australia
Northern Sydney Local Health District, Saint Leonards, New South Wales, Australia
Issue Date: 26-Sep-2019
EDate: 2019-09-26
Citation: Thorax 2019; online first: 26 September
Abstract: Morphine may decrease the intensity of chronic breathlessness but data from a large randomised controlled trial (RCT) are lacking. This first, large, parallel-group trial aimed to test the efficacy and safety of regular, low-dose, sustained-release (SR) morphine compared with placebo for chronic breathlessness. Multisite (14 inpatient and outpatient cardiorespiratory and palliative care services in Australia), parallel-arm, double-blind RCT. Adults with chronic breathlessness (modified Medical Research Council≥2) were randomised to 20 mg daily oral SR morphine and laxative (intervention) or placebo and placebo laxative (control) for 7 days. Both groups could take ≤6 doses of 2.5 mg, 'as needed', immediate-release morphine (≤15 mg/24 hours) as required by the ethics review board. The primary endpoint was change from baseline in intensity of breathlessness now (0-100 mm visual analogue scale; two times per day diary) between groups. Secondary endpoints included: worst, best and average breathlessness; unpleasantness of breathlessness now, fatigue; quality of life; function; and harms. Analysed by intention-to-treat, 284 participants were randomised to morphine (n=145) or placebo (n=139). There was no difference between arms for the primary endpoint (mean difference -0.15 mm (95% CI -4.59 to 4.29; p=0.95)), nor secondary endpoints. The placebo group used more doses of oral morphine solution during the treatment period (mean 8.7 vs 5.8 doses; p=0.001). The morphine group had more constipation and nausea/vomiting. There were no cases of respiratory depression nor obtundation. No differences were observed between arms for breathlessness, but the intervention arm used less rescue immediate-release morphine. ACTRN12609000806268.
URI: http://ahro.austin.org.au/austinjspui/handle/1/21825
DOI: 10.1136/thoraxjnl-2019-213681
ORCID: 0000-0003-1988-1250
0000-0001-6481-3391
PubMed URL: 31558624
Type: Journal Article
Subjects: chronic breathlessness
placebo study
randomised controlled trial
sustained release morphine
symptom relief
Appears in Collections:Journal articles

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