David Currow
speaker
250 appearances
1 recordings
1 series
first heard Jan 2020
last heard Jan 2020
David Currow’s voice in public audio — every appearance, attributed to the second.
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This is one paper from the study.
And there are several other papers that are already following the toxicity paper.
The harms paper is already out there.
And importantly, that's showing no excess signal of harms other than constipation and vomiting.
So we're again reinforcing the meta-analysis from Daisy Janssen's group a couple of years ago that there are no respiratory signals from using regular low-dose sustained-release morphine for the reduction of chronic breathlessness.
Absolutely right.
And if we look at the couple of meta-analyses by Magnus Ekström in the last few years, the one that was published in 2015, I think,
in the annals of the American Thoracic Society is an important one because we moved from just looking at everything that was done to including only studies that got to steady state and then looking at it by disease in the sub-analyses.
And that was a strongly positive study, as was a subsequent meta-analysis published by Magnus a couple of years later.
So we've got...
several meta-analyses that show that systemic opioids, and specifically morphine, and we'll come back to that because there are some other interesting papers that have come out over the last 12 or 18 months, have a symptomatic benefit that is safe and without signal of respiratory depression.
Or the single-dose studies.
So there were a whole lot of single-dose studies way back in the 80s and 90s that have made it into some of those meta-analyses.
And as we did with pain, we needed to think about those studies differently.
Because at the end of the day, single-dose opioids are unlikely to have an effect if we think about both the pharmacokinetics and indeed the pharmacodynamics.
So that's easy.
But you may want to look at the literature where the majority of the studies are done with people who are opioid naive starting a low dose of sustained release morphine.
And when we look at the pharmacokinetics, the peaks are lower, the troughs are higher than if you use immediate release morphine solution or immediate release morphine tablets, for example.
And I have access to 10 milligrams per 24 hours and 20 milligrams per 24 hours.
So that makes an enormous difference.
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