Advanced COPD: sustained-release low-dose morphine offers safe, effective palliation

  • Verberkt CA & al.
  • JAMA Intern Med
  • 17/08/2020

  • Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • In patients with advanced COPD, regular, low-dose, oral sustained-release morphine is associated with better outcomes than placebo and without serious respiratory adverse effects.

Why this matters

  • This study provides the evidence base for morphine's current role in palliative treatment for chronic breathlessness.

Study design

  • In this 4-week MORDYC trial, patients (N=111) were randomly assigned to receive to morphine (10 mg twice daily) or placebo, with the possibility of increasing the intervention to 3 times daily after 1 or 2 weeks.
  • Primary outcomes were scores on the COPD Assessment Test (CAT; with higher scores indicating worse status) and arterial partial pressure of carbon dioxide (PaCO2).
  • Funding: The Netherlands Organisation for Health Research and Development.

Key results

  • The morphine group had better CAT scores (mean difference, 2.18 points lower than placebo; P=.03).
  • The groups did not differ in PaCO2 (morphine group mean difference, 1.19 mm Hg higher than placebo; P=.55).
  • With 1 exception, they also did not differ in breathlessness (P=.19).
    • Exception: a subgroup with the worst breathlessness, which had modified Medical Research Council breathlessness grades 3-4.
    • They had a mean difference of 1.33 points lower than the morphine group (P=.03).

Limitations

  • Low participation (only 27% agreed).
  • No long-term follow-up.