Extended-release morphine of no benefit to COPD patients with breathlessness

A week-long treatment course of low-dose, extended-release morphine does not appear to be effective at relieving breathlessness in patients with chronic obstructive pulmonary disease (COPD), according to a study.

The study enrolled 160 COPD patients with chronic breathlessness (defined as a modified Medical Research Council score 3–4) across 20 centres in Australia. These patients were randomized to receive 8 mg/d or 16 mg/d of extended-release morphine or placebo, administered orally, for 1 week. Then, for weeks 2–3 of treatment, the patients were rerandomized to either 8 mg/d of extended-release morphine, which was added to the prior week’s dose, or placebo.

Of the patients, 156 were included in the primary analyses (median age 72 years, 48 percent female) and 138 (88 percent) completed treatment at week 1 (8 mg/d of morphine group: n=48; 16 mg/d of morphine group: n=43; placebo group: n=47).

At week 1, the primary endpoint of change in the intensity of worst breathlessness on a numerical rating scale (score range, 0 [none] to 10 [being worst or most intense]) was similar in the morphine and placebo groups. The mean differences in scores vs placebo were both −0.3 with the 8 mg/d and 16 mg/d morphine doses.

Likewise, at week 3, the secondary endpoint of change in mean daily step count was not significantly better in the morphine groups vs the placebo group (mean difference, −1,453 steps with 8 mg/d; −1,312 steps with 16 mg/d; −692 steps with 24 mg/d; and −1,924 steps with 32 mg/d of morphine).

The present data do not support the use of the studied extended-release morphine doses to relieve breathlessness in COPD patients.