Opioids in the management of breathlessness in advanced heart failure
ISRCTN | ISRCTN85268059 |
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DOI | https://doi.org/10.1186/ISRCTN85268059 |
Secondary identifying numbers | R&D number RO452 |
- Submission date
- 03/05/2007
- Registration date
- 04/09/2007
- Last edited
- 04/07/2011
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Circulatory System
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Plain English summary of protocol
Not provided at time of registration
Contact information
Dr Stephen Oxberry
Scientific
Scientific
Academic Cardiology
Xray 3 Building
Castle Hill Hospital
Castle Road
Cottingham
Hull
HU16 5JQ
United Kingdom
Study information
Study design | This study is a three arm randomised double blind placebo controlled clinical crossover trial. Participants and observers will remain blinded throughout. |
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Primary study design | Interventional |
Secondary study design | Randomised controlled trial |
Study setting(s) | Not specified |
Study type | Treatment |
Participant information sheet | Not available in web format, please use the contact details below to request a patient information sheet |
Scientific title | |
Study objectives | Opioids are currently used in the management of breathlessness in palliative patients at the end of life. There is a small but growing evidence base regarding the use of opioids to manage breathlessness in lung cancer and Chronic Obstructive Pumonary Disease (COPD). A pilot placebo controlled crossover study involving oramorph in ten heart failure patients demonstrated symptom improvement and two studies involving opioids in exercise revealed an improvement in exercise tolerance. Morphine is also used clinically to treat acute pulmonary oedema. The manner in which opioids improve breathlessness is unclear, but is likely to represent a combination of local effects in the lung and heart, effect at the respiratory centre in the brain and neurohumeral effects. Our aim is to demonstrate a symptom benefit regarding breathlessness with opioids and to determine if this is a class effect and whether opioids that interact with different opioid receptors have different outcomes. |
Ethics approval(s) | Ethics approval received from the Leeds East Ethics Committee on the 9th October 2007 (ref: 07/H1306/110). |
Health condition(s) or problem(s) studied | Chronic heart failure |
Intervention | Please note that as of 29/04/2008 the anticipated start date of this trial was changed to 01/05/2008; the previous start date was 01/07/2007. The two active intervention arms involve low dose oral liquid morphine (oramorph 5 mg four times a day [QDS]) and oral oxycodone liquid (oxynorm 2.5 mg QDS). The sequence of interventions will be randomised for each participant and all participants will receive all three treatment arms. Participants will be invited to take the medication (oramorph, oxynorm or placebo) for four consecutive days. There will be daily assessments of breathlessness and side effects during this time. A three-day washout period will occur before commencing the next treatment in sequence. |
Intervention type | Drug |
Pharmaceutical study type(s) | |
Phase | Not Specified |
Drug / device / biological / vaccine name(s) | Morphine (oramorph), oxycodone (oxynorm) |
Primary outcome measure | Severity of breathlessness as measured by the Borg validated score for breathlessness and 11 point Numerical Rating Scale (worst, average and current readings), measured daily whilst taking the trial medications. |
Secondary outcome measures | 1. Distress from breathlessness, measured on days one and four for each trial medication (the first and last days participants take it) 2. Satisfaction and coping, measured daily whilst taking the trial medications 3. Breathlessness descriptors, measured on days one and four for each trial medication (the first and last days participants take it) 4. Adverse effect scores, measured daily whilst taking the trial medications 5. Quality of life, measured on days one and four for each trial medication (the first and last days participants take it) |
Overall study start date | 01/05/2008 |
Completion date | 01/12/2008 |
Eligibility
Participant type(s) | Patient |
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Age group | Adult |
Lower age limit | 18 Years |
Sex | Not Specified |
Target number of participants | 48 |
Key inclusion criteria | 1. New York Heart Association (NYHA) grade three to four chronic heart failure with systolic dysfunction on echocardiography 2. Receiving optimal medical management (diuretics and Angiotensin Converting Enzymes [ACE] inhibitors/angiotensin 2 antagonists) stable for the past month 3. Aged 18 years and over |
Key exclusion criteria | 1. Inadequate renal function (Glomerular Filtration Rate [GFR] less than 30 ml/min on Cockroft/Gault formula) 2. Morphine allergy 3. Currently receiving opioid therapy |
Date of first enrolment | 01/05/2008 |
Date of final enrolment | 01/12/2008 |
Locations
Countries of recruitment
- England
- United Kingdom
Study participating centre
Academic Cardiology
Hull
HU16 5JQ
United Kingdom
HU16 5JQ
United Kingdom
Sponsor information
Hull and East Yorkshire Hospitals NHS Trust (UK)
Hospital/treatment centre
Hospital/treatment centre
Research and Development Department
Hull Royal Infirmary
Anlaby Road
Hull
HU3 2RJ
England
United Kingdom
Website | http://www.hey.nhs.uk/ |
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https://ror.org/01b11x021 |
Funders
Funder type
Government
Hull York Medical School (HYMS) Clinical Fellowship Scheme (funded by the NHS local Strategic Health Authority) (UK)
No information available
Results and Publications
Intention to publish date | |
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Individual participant data (IPD) Intention to share | No |
IPD sharing plan summary | Not provided at time of registration |
Publication and dissemination plan | Not provided at time of registration |
IPD sharing plan |
Study outputs
Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
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Results article | results | 01/09/2011 | Yes | No |