Effect of Sustained-Release Morphine for Refractory Breathlessness in Chronic Obstructive Pulmonary Disease on Health Status: A Randomized Clinical Trial. Verberkt, C. A., Everdingen, M. H. J. v. d. B., Schols, J. M. G. A., Hameleers, N., Wouters, E. F. M., & Janssen, D. J. A. JAMA Internal Medicine, August, 2020.
Effect of Sustained-Release Morphine for Refractory Breathlessness in Chronic Obstructive Pulmonary Disease on Health Status: A Randomized Clinical Trial [link]Paper  doi  abstract   bibtex   
\textlessh3\textgreaterImportance\textless/h3\textgreater\textlessp\textgreaterMorphine is used as palliative treatment of chronic breathlessness in patients with advanced chronic obstructive pulmonary disease (COPD). Evidence on respiratory adverse effects and health status is scarce and conflicting.\textless/p\textgreater\textlessh3\textgreaterObjective\textless/h3\textgreater\textlessp\textgreaterTo 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 patients with COPD.\textless/p\textgreater\textlessh3\textgreaterInterventions\textless/h3\textgreater\textlessp\textgreaterParticipants 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.\textless/p\textgreater\textlessh3\textgreaterDesign, Setting, and Participants\textless/h3\textgreater\textlessp\textgreaterThe 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. Patients were enrolled between November 1, 2016, and January 24, 2019. Participants were recruited in a pulmonary rehabilitation center and 2 general hospitals after completion of a pulmonary rehabilitation program. 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 were included. A total of 1380 patients were screened, 916 were ineligible, and 340 declined to participate.\textless/p\textgreater\textlessh3\textgreaterMain Outcomes and Measures\textless/h3\textgreater\textlessp\textgreaterPrimary outcomes were CAT score (higher scores represent worse health status) and arterial partial pressure of carbon dioxide (Paco$_{\textrm{2}}$). Secondary outcome was breathlessness in the previous 24 hours (numeric rating scale). Data were analyzed by intention to treat. Subgroup analyses in participants with mMRC grades 3 to 4 were performed.\textless/p\textgreater\textlessh3\textgreaterResults\textless/h3\textgreater\textlessp\textgreaterA total of 111 of 124 included participants were analyzed (mean [SD] age, 65.4 [8.0] years; 60 men [54%]). Difference in CAT score was 2.18 points lower in the morphine group (95% CI, –4.14 to –0.22 points;P = .03). Difference in Paco$_{\textrm{2}}$was 1.19 mm Hg higher in the morphine group (95% CI, –2.70 to 5.07 mm Hg;P = .55). Breathlessness remained unchanged. Worst breathlessness improved in participants with mMRC grades 3 to 4 (1.33 points lower in the morphine group; 95% CI, –2.50 to –0.16 points;P = .03). 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.\textless/p\textgreater\textlessh3\textgreaterConclusions and Relevance\textless/h3\textgreater\textlessp\textgreaterIn 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 Paco$_{\textrm{2}}$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.\textless/p\textgreater\textlessh3\textgreaterTrial Registration\textless/h3\textgreater\textlessp\textgreaterClinicalTrials.gov Identifier:NCT02429050\textless/p\textgreater
@article{verberkt_effect_2020,
	title = {Effect of {Sustained}-{Release} {Morphine} for {Refractory} {Breathlessness} in {Chronic} {Obstructive} {Pulmonary} {Disease} on {Health} {Status}: {A} {Randomized} {Clinical} {Trial}},
	shorttitle = {Effect of {Sustained}-{Release} {Morphine} for {Refractory} {Breathlessness} in {Chronic} {Obstructive} {Pulmonary} {Disease} on {Health} {Status}},
	url = {https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2769373},
	doi = {10.1001/jamainternmed.2020.3134},
	abstract = {{\textless}h3{\textgreater}Importance{\textless}/h3{\textgreater}{\textless}p{\textgreater}Morphine is used as palliative treatment of chronic breathlessness in patients with advanced chronic obstructive pulmonary disease (COPD). Evidence on respiratory adverse effects and health status is scarce and conflicting.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Objective{\textless}/h3{\textgreater}{\textless}p{\textgreater}To 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 patients with COPD.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Interventions{\textless}/h3{\textgreater}{\textless}p{\textgreater}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.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Design, Setting, and Participants{\textless}/h3{\textgreater}{\textless}p{\textgreater}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. Patients were enrolled between November 1, 2016, and January 24, 2019. Participants were recruited in a pulmonary rehabilitation center and 2 general hospitals after completion of a pulmonary rehabilitation program. 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 were included. A total of 1380 patients were screened, 916 were ineligible, and 340 declined to participate.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Main Outcomes and Measures{\textless}/h3{\textgreater}{\textless}p{\textgreater}Primary outcomes were CAT score (higher scores represent worse health status) and arterial partial pressure of carbon dioxide (Paco$_{\textrm{2}}$). Secondary outcome was breathlessness in the previous 24 hours (numeric rating scale). Data were analyzed by intention to treat. Subgroup analyses in participants with mMRC grades 3 to 4 were performed.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Results{\textless}/h3{\textgreater}{\textless}p{\textgreater}A total of 111 of 124 included participants were analyzed (mean [SD] age, 65.4 [8.0] years; 60 men [54\%]). Difference in CAT score was 2.18 points lower in the morphine group (95\% CI, –4.14 to –0.22 points;\textit{P} = .03). Difference in Paco$_{\textrm{2}}$was 1.19 mm Hg higher in the morphine group (95\% CI, –2.70 to 5.07 mm Hg;\textit{P} = .55). Breathlessness remained unchanged. Worst breathlessness improved in participants with mMRC grades 3 to 4 (1.33 points lower in the morphine group; 95\% CI, –2.50 to –0.16 points;\textit{P} = .03). 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.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Conclusions and Relevance{\textless}/h3{\textgreater}{\textless}p{\textgreater}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 Paco$_{\textrm{2}}$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.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Trial Registration{\textless}/h3{\textgreater}{\textless}p{\textgreater}ClinicalTrials.gov Identifier:NCT02429050{\textless}/p{\textgreater}},
	language = {en},
	urldate = {2020-10-02},
	journal = {JAMA Internal Medicine},
	author = {Verberkt, Cornelia A. and Everdingen, Marieke H. J. van den Beuken-van and Schols, Jos M. G. A. and Hameleers, Niels and Wouters, Emiel F. M. and Janssen, Daisy J. A.},
	month = aug,
	year = {2020},
}
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