The Effectiveness and Safety of Buprenorphine in Palliative Care: A Systematic Review of Randomized Controlled Trials, Prospective and Retrospective Studies

Abstract

Context: Buprenorphine is increasingly used for pain relief in palliative care settings due to its potent analgesic properties, favorable safety profile, and lower risk of inducing opioid use disorder compared to full opioid agonists.

Objectives: We performed a systematic review of buprenorphine's analgesic efficacy and risk of adverse effects.

Methods: We searched PubMed, Embase, and Web of Science in July 2024 for studies on buprenorphine administration to palliative care patients. We excluded animal studies, patients without a terminal diagnosis, and studies in children. Our final sample included 15 Randomized Controlled Trials (RCTs), 19 prospective studies, and nine retrospective studies.

Results: Fourteen out of 15 RCTs evaluated buprenorphine's analgesic efficacy. Six RCTs evaluating short-acting use found buprenorphine exhibited comparable efficacy to other short-acting full-opioid agonists (including morphine, tramadol, and fentanyl). Of the five RCTs investigating buprenorphine as a long-acting opioid, four found equal or superior efficacy as compared to long-acting fentanyl, morphine, and oxycodone. All placebo-controlled RCTs, as well as prospective and retrospective studies reported that transdermal buprenorphine was significantly effective as a long-acting analgesic. Across all comparisons (short-, long-acting, and placebo), buprenorphine had side effects that were not statistically distinguishable from other full-opioid agonists.

Conclusion: Our systematic review found consistent evidence that buprenorphine was comparable to other full opioid agonists when used as both a short-acting and long-acting analgesic for palliative care patients. It also did not display significant differences in risks of adverse effects. Future research is needed to compare alternative delivery, dosing, and duration strategies for palliative care patients, as well as to better evaluate impact on overall patient quality of life and well-being.

Keywords: adverse effects; analgesic efficacy; buprenorphine; palliative care; safety.