• Johann D Ringe, Susanne Schäfer, Antonie M Wimmer, and Thorsten Giesecke.
• Direktor der Med. Klinik 4, Allgemeine Innere und Westdeutsches Osteoporose Zentrum, Klinikum Leverkusen GmbH, Leverkusen, Germany.
• Wien. Klin. Wochenschr. 2012 Jan 1;124(1-2):25-31.

ObjectiveTo determine the effect of a lower starting dose of OROS® hydromorphone compared with a higher starting dose.DesignData from the first 15 days of treatment were compared in a combined analysis of three prospective, non-interventional studies.SettingNon-interventional, carried out in daily routine settings.PatientsPatients had chronic severe pain due to osteoarthritis or from fragility fractures related to osteoporosis.InterventionsOROS-ANA-4001 and OROS-ANA-4002 had a daily starting dose of 8 mg of OROS® hydromorphone; OROS-ANA-4003 had a daily starting dose of 4 mg.Main Outcome Measure(S)A post-hoc analysis to assess the effect of a low starting dose of OROS® hydromorphone on tolerability, pain control, and treatment satisfaction overall and for subgroups of opioid-naïve patients versus patients previously treated with opioids, and patients aged >65 years versus patients aged ≤65 years.ResultsTreatment satisfaction and pain control improved in all studies; treatment satisfaction improved in a higher percentage of patients in the lower starting dose group. Gastrointestinal disorders were the most frequent treatment-emergent adverse events. Incidence of nausea was comparable between studies. Incidence of constipation, vomiting, fatigue, and pruritus was less frequent with the lower starting dose. In elderly and opioid-naïve patients, a lower starting dose was associated with lower overall incidence of adverse events, treatment-related adverse events, and those leading to discontinuation.ConclusionsA lower starting dose was associated with better tolerability and a lower number of treatment terminations at a comparable level of pain control with high treatment satisfaction.

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