Tapentadol IR Better Tolerarated Than Oxycodone IR in Hospitalized Patients

LAS VEGAS, NV—An analysis of tapentadol immediate-release (TAP-IR) showed that it may offer an effective pain management option for post-operative hospitalized patients, as reported at PAINWeek 2012. Tapentadol immediate-release is a centrally acting analgesic that acts through mu-opioid receptor agonism and norepinephrine reuptake inhibition. It is indicated for the relief of moderate-to-severe acute pain in adults.

Jay Lin, PhD, from Novosys Health, Flemington, NJ, and colleagues, followed up on a prior comparative analysis of TAP-IR and oxycodone immediate-release (OXY-IR) that suggested that at equianalgesic dosages, TAP-IR is associated with a better tolerability profile than OXY-IR while providing similar pain relief. However, real-world use of TAP-IR may differ from OXY-IR, which may affect the results of comparative analysis of patient outcomes.

The researchers designed a study to evaluate the real-world frequency of adverse events—as determined by use of TAP-IR and OXY-IR in a group of hospitalized patients with similar baseline characteristics. Dr. Lin and his colleagues used data from the Premier Perspective, the largest integrated inpatient drug use database (comprising data from 600 hospitals throughout the U.S.). Investigators analyzed patients hospitalized between June 1, 2009–September 30, 2011 who received at least one prescription for TAP-IR or OXY-IR.

TAP-IR users were matched to OXY-IR users (1:3) using a combination of exact match of key patient characteristics and propensity score, matching with patient demographics and clinical characteristics as covariates. Several patient differences were noted among the unmatched cohorts. After patient matching, TAP-IR patients (n=1,858) and OXY-IR patients (n=5,574) demonstrated similar age (mean=62.20 years vs 61.77 years), gender (70.72% female vs 70.72%), and in mean Charlson Comorbidity Index score (0.66 vs 0.67).

Notably, a greater proportion of TAP-IR patients vs OXY-IR patients received antinausea medication (51.29% vs  41.32%, P<0.0001), and/or medication for constipation (23.36% vs 16.59%, P<0.0001) prior to initiation of pain medications. However, after initiation of corresponding medications for pain, a smaller proportion of TAP-IR patients compared with those who received OXY-IR were prescribed medication to treat nausea (29.87% vs 33.98%; P=0.0011) and/or constipation (27.50% vs 34.93%, P<0.0001).

Based on the study's findings, Dr. Lin and colleagues were able to conclude that hospitalized patients who use TAP-IR may benefit from its better tolerability profile than those who use a traditional mu-opioid receptor agonist.