Association between dynamic dose increases of buprenorphine for treatment of opioid use disorder and risk of relapse.
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| Title: | Association between dynamic dose increases of buprenorphine for treatment of opioid use disorder and risk of relapse. |
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| Authors: | Rudolph, Kara E., Shulman, Matisyahu, Fishman, Marc, Díaz, Iván, Rotrosen, John, Nunes, Edward V. |
| Source: | Addiction. Mar2022, Vol. 117 Issue 3, p637-645. 9p. 1 Chart, 1 Graph. |
| Subjects: | Substance abuse, Confidence intervals, Buprenorphine, Risk assessment, Descriptive statistics, Data analysis software, Secondary analysis |
| Geographic Terms: | United States |
| Abstract: | Background and Aims: Dynamic, adaptive pharmacologic treatment for opioid use disorder (OUD) has been previously recommended over static dosing to prevent relapse, and is aligned with personalized medicine. However, there has been no quantitative evidence demonstrating its advantage. Our objective was to estimate the extent to which a hypothetical intervention that increased buprenorphine dose in response to opioid use would affect risk of relapse over 24 weeks of follow-up. Design: A secondary analysis of the buprenorphine arm of an open-label randomized controlled 24-week comparative effectiveness trial, 2014-17. Setting: Eight community addiction treatment programs in the United States. Participants: English-speaking adults with DSM-5 OUD, recruited during inpatient admission (n = 270). Participants were mainly white (65%) and male (72%). Intervention(s): Participants were treated with daily sublingual buprenorphine-naloxone (BUP-NX), with dose based on clinical indication, determined by the provider. We examined a hypothetical intervention of increasing dose in response to opioid use. Measurements: Outcome was relapse to regular opioid use during the 24 weeks of outpatient treatment, assessed in a survival framework. We estimated the relapse-free survival curves of participants under a hypothetical (i.e. counterfactual) intervention in which their BUP-NX dosage would be increased following their own subject-specific opioid use during the first 12 weeks of treatment versus a hypothetical intervention in which dose would remain constant. Findings: We estimated that increasing BUP-NX dose in response to recent opioid use would lower risk of relapse by 19.17 percentage points [95% confidence interval (CI) = -32.17, -6.18) (additive risk)] and 32% (0.68, 95% CI = 0.49, 0.86) (relative risk). The number-needed-to-treat with this intervention to prevent a single relapse is 6. Conclusions: In people with opioid use disorder, a hypothetical intervention that increases sublingual buprenorphine-naloxone dose in response to opioid use during the first 12 weeks of treatment appears to reduce risk of relapse over 24 weeks, compared with holding the dose constant after week 2. [ABSTRACT FROM AUTHOR] |
| Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Psychology and Behavioral Sciences Collection |
| FullText | Links: – Type: pdflink Text: Availability: 0 |
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| Header | DbId: pbh DbLabel: Psychology and Behavioral Sciences Collection An: 155882838 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Association between dynamic dose increases of buprenorphine for treatment of opioid use disorder and risk of relapse. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Rudolph%2C+Kara+E%2E%22">Rudolph, Kara E.</searchLink><br /><searchLink fieldCode="AR" term="%22Shulman%2C+Matisyahu%22">Shulman, Matisyahu</searchLink><br /><searchLink fieldCode="AR" term="%22Fishman%2C+Marc%22">Fishman, Marc</searchLink><br /><searchLink fieldCode="AR" term="%22Díaz%2C+Iván%22">Díaz, Iván</searchLink><br /><searchLink fieldCode="AR" term="%22Rotrosen%2C+John%22">Rotrosen, John</searchLink><br /><searchLink fieldCode="AR" term="%22Nunes%2C+Edward+V%2E%22">Nunes, Edward V.</searchLink> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Addiction%22">Addiction</searchLink>. Mar2022, Vol. 117 Issue 3, p637-645. 9p. 1 Chart, 1 Graph. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22Substance+abuse%22">Substance abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Buprenorphine%22">Buprenorphine</searchLink><br /><searchLink fieldCode="DE" term="%22Risk+assessment%22">Risk assessment</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis+software%22">Data analysis software</searchLink><br /><searchLink fieldCode="DE" term="%22Secondary+analysis%22">Secondary analysis</searchLink> – Name: SubjectGeographic Label: Geographic Terms Group: Su Data: <searchLink fieldCode="DE" term="%22United+States%22">United States</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Background and Aims: Dynamic, adaptive pharmacologic treatment for opioid use disorder (OUD) has been previously recommended over static dosing to prevent relapse, and is aligned with personalized medicine. However, there has been no quantitative evidence demonstrating its advantage. Our objective was to estimate the extent to which a hypothetical intervention that increased buprenorphine dose in response to opioid use would affect risk of relapse over 24 weeks of follow-up. Design: A secondary analysis of the buprenorphine arm of an open-label randomized controlled 24-week comparative effectiveness trial, 2014-17. Setting: Eight community addiction treatment programs in the United States. Participants: English-speaking adults with DSM-5 OUD, recruited during inpatient admission (n = 270). Participants were mainly white (65%) and male (72%). Intervention(s): Participants were treated with daily sublingual buprenorphine-naloxone (BUP-NX), with dose based on clinical indication, determined by the provider. We examined a hypothetical intervention of increasing dose in response to opioid use. Measurements: Outcome was relapse to regular opioid use during the 24 weeks of outpatient treatment, assessed in a survival framework. We estimated the relapse-free survival curves of participants under a hypothetical (i.e. counterfactual) intervention in which their BUP-NX dosage would be increased following their own subject-specific opioid use during the first 12 weeks of treatment versus a hypothetical intervention in which dose would remain constant. Findings: We estimated that increasing BUP-NX dose in response to recent opioid use would lower risk of relapse by 19.17 percentage points [95% confidence interval (CI) = -32.17, -6.18) (additive risk)] and 32% (0.68, 95% CI = 0.49, 0.86) (relative risk). The number-needed-to-treat with this intervention to prevent a single relapse is 6. Conclusions: In people with opioid use disorder, a hypothetical intervention that increases sublingual buprenorphine-naloxone dose in response to opioid use during the first 12 weeks of treatment appears to reduce risk of relapse over 24 weeks, compared with holding the dose constant after week 2. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
| PLink | https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=155882838 |
| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1111/add.15654 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 9 StartPage: 637 Subjects: – SubjectFull: Substance abuse Type: general – SubjectFull: Confidence intervals Type: general – SubjectFull: Buprenorphine Type: general – SubjectFull: Risk assessment Type: general – SubjectFull: Descriptive statistics Type: general – SubjectFull: Data analysis software Type: general – SubjectFull: Secondary analysis Type: general – SubjectFull: United States Type: general Titles: – TitleFull: Association between dynamic dose increases of buprenorphine for treatment of opioid use disorder and risk of relapse. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Rudolph, Kara E. – PersonEntity: Name: NameFull: Shulman, Matisyahu – PersonEntity: Name: NameFull: Fishman, Marc – PersonEntity: Name: NameFull: Díaz, Iván – PersonEntity: Name: NameFull: Rotrosen, John – PersonEntity: Name: NameFull: Nunes, Edward V. IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 03 Text: Mar2022 Type: published Y: 2022 Identifiers: – Type: issn-print Value: 09652140 Numbering: – Type: volume Value: 117 – Type: issue Value: 3 Titles: – TitleFull: Addiction Type: main |
| ResultId | 1 |
