Netherlands: Oral sustained-release morphine for 4 weeks positively impacts COPD patients, suggests a recent study in JAMA Internal Medicine. The study found that regular, low-dose, oral sustained-release morphine for 4 weeks improves health status in COPD patients without causing serious adverse effects or affecting Paco2.
Morphine is used as a palliative treatment for chronic breathlessness in advanced chronic obstructive pulmonary disease (COPD) patients. However, there is scarce and conflicting evidence on respiratory adverse effects and health status. To shed light on the same, Cornelia A. Verberkt, Maastricht University, Maastricht, the Netherlands, and colleagues assess the effects of regular, low-dose, oral sustained-release morphine on disease-specific health status (COPD Assessment Test; CAT), respiratory outcomes, and breathlessness in COPD patients.
The Morphine for Treatment of Dyspnea in Patients With COPD (MORDYC) study was a randomized, double-blind, and placebo-controlled study of a 4-week intervention. A total of 111 of 124 included participants were analyzed. Thye were recruited in a pulmonary rehabilitation center and 2 general hospitals after completion of a pulmonary rehabilitation program. It included outpatients with COPD and moderate to very severe chronic breathlessness (modified Medical Research Council [mMRC] breathlessness grades 2-4) despite optimal pharmacological and nonpharmacological treatment.
Participants were randomly assigned to 10 mg of regular, oral sustained-release morphine or placebo twice daily for 4 weeks, with the possibility to increase to 3 times daily after 1 or 2 weeks.
Primary outcomes were CAT score (higher scores represent worse health status) and arterial partial pressure of carbon dioxide (Paco2).
Key findings of the study include:
Difference in CAT score was 2.18 points lower in the morphine group.
Difference in Paco2 was 1.19 mm Hg higher in the morphine group.
Breathlessness remained unchanged. Worst breathlessness improved in participants with mMRC grades 3 to 4 (1.33 points lower in the morphine group).
Five participants of 54 in the morphine group (9%) and 1 participant of 57 in the placebo group (2%) withdrew because of adverse effects.
No morphine-related hospital admissions or deaths occurred.
"In this randomized clinical trial, regular, low-dose, oral sustained-release morphine for 4 weeks improved disease-specific health status in patients with COPD without affecting Paco2 or causing serious adverse effects. The worst breathlessness improved in participants with mMRC grades 3 to 4. A larger randomized clinical trial with longer follow-up in patients with mMRC grades 3 to 4 is warranted," concluded the authors.
The study, "Effect of Sustained-Release Morphine for Refractory Breathlessness in Chronic Obstructive Pulmonary Disease on Health Status: A Randomized Clinical Trial," is published in the journal JAMA Internal Medicine.
DOI: 10.1001/jamainternmed.2020.3134