Claudio Lo Presti

Publications (2)5.39 Total impact

• Source

  Available from: Sebastiano Mercadante

  Article: The Effects of Low Doses of Pregabalin on Morphine Analgesia in Advanced Cancer Patients.

  Sebastiano Mercadante, Giampiero Porzio, Federica Aielli, Patrizia Ferrera, Luigi Codipietro, Claudio Lo Presti, Alessandra Casuccio
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  ABSTRACT: OBJECTIVES:: The aim of this study was to evaluate the opioid response in patients receiving morphine and pregabalin, independently from the presumed pain mechanisms, in comparison with patients receiving morphine treatment only. METHODS:: A multicenter prospective randomized controlled study was carried out in a sample of 70 advanced cancer patients with pain requiring strong opioids. Thirty-five patients (group MO) were randomized to receive sustained-release morphine using initial doses of 60 mg/day. Thirty-five patients (group MO-PR) were randomized to start the same morphine doses and pregabalin in increasing doses, starting with 25 mg/day up to 150 mg/day in one week. The following data were also recorded before starting the treatments (T0) and then at week intervals for four weeks (W1-4): age, gender, primary cancer and known metastases, pain causes and mechanisms, symptoms associated with opioid therapy, pain intensity, Brief Pain Inventory (BPI), morphine doses and escalation indexes (OEIs), and quality of life. RESULTS:: Forty-eight patients completed the study, twenty-eight and sixteen patients in group MO and MO-PR, respectively. Twenty patients were females, the mean age was 65.5 (±10.3), and the mean Karnofsky status was 66.0 (±18.9). No differences between groups were found in age (P=0.839), Karnofsky status (P=0.741), opioid doses as well as escalation indexes (OEI mg, P=0.260, and OEI%, P=0.270). No differences between the two groups were found in quality of life and all BPI items. CONCLUSION:: The use of low doses of pregabalin added to morphine therapy in advanced cancer patients does not seem to provide advantageous analgesic effects, despite limitations of the present study due to the number of drop-outs.
  The Clinical journal of pain 04/2012; · 3.01 Impact Factor
• Source

  Available from: Sebastiano Mercadante

  Article: Dosing fentanyl buccal tablet for breakthrough cancer pain: dose titration versus proportional doses.

  Sebastiano Mercadante, Antonio Gatti, Giampiero Porzio, Claudio Lo Presti, Federica Aielli, Claudio Adile, Alessandra Casuccio
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  ABSTRACT: The aim of this study was to compare the efficacy and safety of doses of fentanyl buccal tablet (FBT) proportional to doses of opioids used for background analgesia versus dose titration starting with the minimal dose for the management of breakthrough cancer pain (BTcP). A total of 82 cancer patients with BTcP who were receiving strong opioids in doses of at least 60 mg of oral morphine equivalents and having acceptable background analgesia, were selected for a multicenter unblinded study. Forty-one patients were randomized to receive FBT in doses proportional to the daily opioid doses for four consecutive episodes of BTcP (group P). Forty-one patients underwent dose titration of FBT, with an initial dose of 100 µg, for four consecutive episodes (group T). Pain intensity and symptoms associated with opioid therapy were measured before administering any dose of FBT (T0) and 15 minutes after (T15). In all, 80 patients were considered for analysis (39 and 41 patients in group P and T, respectively). Patients were receiving a mean of 126 ± 100 mg of oral morphine equivalents (range 60-480 mg) for background analgesia. A total of 293 episodes of BTcP (144 and 149 in group P and T, respectively) were treated and considered for analysis. No differences were found in the decrease of pain intensity between the two groups. However, in patients receiving doses of oral morphine equivalents of >120 mg/day, a significant number of patients obtained a decrease in pain intensity >50% in group P in comparison with group T (p = 0.040). Also, the need for rescue medication was significantly more frequently reported in group T for the first episode of BTcP (p < 0.0005). No differences in the level of adverse effects were observed between the two groups. No differences in patients' satisfaction were reported. According to the data obtained in this study, there is no evidence for the use of dose titration in the management of BTcP in opioid-tolerant patients. Indeed, doses proportional to basal opioid regimen for background pain seem to be effective and safe in the majority of patients. Further studies should confirm this data in patients receiving higher doses of opioids, with other rapid-onset opioids, and in other settings.
  Current Medical Research and Opinion 04/2012; 28(6):963-8. · 2.38 Impact Factor