Cachectic patients frequently require transdermal fentanyl (TDF) for pain management, but data on its efficacy and safety are scarce and inconsistent. This scoping review aims to analyze the evidence concerning TDF administration in patients with cachexia irrespective of the underlying pathology. The primary objective is to assess the analgesic efficacy and tolerability of TDF in cachectic patients. The secondary objective is to identify cachexia characteristics that may influence fentanyl pharmacokinetics (PK). A comprehensive search of PubMed, Embase, and Web of Science databases was conducted up to March 2024. The review included observational and clinical studies on cachectic patients with moderate to severe pain treated with TDF patches at any dosage or frequency. Phase 1 trials, animal studies, case reports, preclinical studies and conference abstracts were excluded. Nine studies were included: four studies reported that cachexia negatively impacted TDF efficacy, increasing required doses and lowering plasma concentrations; three studies found minimal or no impact of cachexia on TDF efficacy and PK; two studies suggested that cachexia might improve TDF outcomes. Study quality ranged from moderate to high, according to the National Institutes of Health (NIH) Quality Assessment Tool. The current evidence is insufficient to provide any definitive recommendations for TDF prescribing in cachectic patients.
恶病质患者常需使用透皮芬太尼（TDF）进行疼痛管理，但其疗效与安全性的数据稀缺且不一致。本范围综述旨在分析不同病因恶病质患者使用TDF的相关证据，主要评估TDF对恶病质患者的镇痛效果及耐受性，次要目标是识别可能影响芬太尼药代动力学（PK）的恶病质特征。截至2024年3月，我们对PubMed、Embase和Web of Science数据库进行了全面检索，纳入观察性和临床研究，研究对象为使用任意剂量或频率TDF贴剂治疗中重度疼痛的恶病质患者，排除Ⅰ期试验、动物研究、病例报告、临床前研究及会议摘要。共纳入9项研究：其中4项研究表明恶病质对TDF疗效产生负面影响，需增加剂量且降低血浆浓度；3项研究发现恶病质对TDF疗效及PK影响甚微或无影响；2项研究提示恶病质可能改善TDF疗效。根据美国国立卫生研究院（NIH）质量评估工具，研究质量从中等到较高不等。现有证据尚不足以就恶病质患者的TDF处方提供明确建议。
Transdermal Fentanyl in Patients with Cachexia—A Scoping Review
肿瘤(癌症)患者之家