Poster presentation at the Anesthesiology 2022 annual meeting compares oliceridine and morphine on ventilation in an elderly population

In the abstract, the authors highlighted the key findings of the randomized, double blind, crossover study. The study compared the analgesic and hypercapnic ventilatory responses of two doses of Olinvyk (oliceridine) injection (0.5mg and 2.0mg) against two doses of IV morphine (2.0mg and 8.0mg) in a population of healthy elderly individuals (age range 56 to 87 years, mean age = 71.2) across a range of body weights (BMI range from 20 to 34 kg/m2, mean BMI = 26.3). Subjects were randomized by drug and dose and tested on 4 separate days.

The study design is important given that older age and increased weight are clinically known to represent risk factors for the development of respiratory depression with the use of opioid medications. The primary endpoint of the study was the ventilatory rate in response to inhaled carbon dioxide at an extrapolated end-tidal PCO2 of 55 mm Hg (VE55). The study was led by Dr. Dahan in collaboration with his research team at University Medical Center in Leiden, the Netherlands.

The key findings from the study were: i. Overall: Both IV Olinvyk and IV morphine showed comparable levels of pain relief in response to anterior tibial electrical stimulation. IV Olinvyk, however, has a significantly reduced effect on respiratory function over time compared to IV morphine, as measured by the mean ventilatory profiles over time (P<0.0001). ii. lower dose: in contrast to lower dose iv morphine, the lower dose iv olinvyk showed very little impact on respiratory function. iii.higher dose: at the higher doses studied, less respiratory depression was seen over the 6-hour measurement period with iv olinvyk. the peak level of respiratory depression was lower for iv olinvyk compared to iv morphine, but this difference was not statistically significant (p> 0.05). Respiratory function rapidly returned toward baseline from 3 hours onward among IV Olinvyk subjects compared to IV morphine (P < 0.05 at all timepoints in pairwise comparisons). iv. Consistent with Prior Data. These data replicate differential effects of IV Olinvyk versus IV morphine seen in an earlier study in a younger population. Comparing these results with the earlier study in younger subjects, these data confirm the known risk of older age as a clinical risk factor and demonstrate an increased sensitivity to opioid-induced respiratory depression among these elderly subjects.

As with all opioids, serious, life-threatening, or fatal respiratory depression may occur in patients treated with Olinvyk as indicated in the boxed warning.