Comparative effectiveness of extended release naltrexone and sublingual buprenorphine for treatment of opioid use disorder among Medicaid patients.
Comparative effectiveness of extended release naltrexone and sublingual buprenorphine for treatment of opioid use disorder among Medicaid patients.
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缓释纳曲酮和舌下含服丁丙诺啡治疗医疗补助患者阿片类药物使用障碍的效果比较。
DOI：
10.1101/2024.01.24.24301555
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Rudolph,KaraE
中科院分区：
文献类型：
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作者：
Ross,RachaelK;Nunes,EdwardV;Olfson,Mark;Shulman,Matisyahu;Krawczyk,Noa;Stuart,ElizabethA;Rudolph,KaraE
缓释纳洛酮（XR‐NTX）和舌下丁丙诺啡（SL‐BUP）都被批准用于任何医疗环境中的阿片类药物使用障碍（OUD）治疗。我们旨在比较XR‐NTX和SL‐BUP的真实的世界有效性。设计和设置这是一项观察性活性对照药物、新用户队列研究，对美国新泽西和加州患者的医疗补助索赔记录进行研究，2016- 19.参与者/案例参与者是18- 19岁的成年医疗补助患者，64岁，开始XR‐NTX或SL‐BUP用于OUD维持治疗，并且在开始前90天内未使用OUD药物。我们的队列包括1755名XR‐NTX和9886名SL‐BUP患者。测量我们检查了开始用药后180天的两个结局：（1）停药和死亡的复合结局和（2）用药过量和死亡的复合结局。结果在校正分析中，XR‐NTX治疗比SL‐BUP治疗更可能导致随访结束时停药或死亡：累积风险分别为75.9% [95%置信区间（CI）= 73.9%，77.9%]和62.2%（95% CI = 61.2%，63.2%）（风险差异= 13.7个百分点，95% CI = 11.4，16.0）。随访结束时，药物过量或死亡的累积风险差异极小：XR‐NTX 3.9%（95% CI = 3.0%，4.8%）vs SL‐BUP 3.3%（95% CI = 2.9%，3.7%）;风险差异= 0.5个百分点，95% CI =-0.4，1.5。结果是一致的敏感性analysis.ConclusionsMedicaid患者在加州和新泽西，美国，接受治疗阿片类药物使用障碍留在治疗舌下丁丙诺啡比缓释纳洛酮，但过量的风险是相似的。本研究中的大多数患者在6个月内停止用药，无论开始使用哪种药物。
Background and aimsExtended‐release naltrexone (XR‐NTX) and sublingual buprenorphine (SL‐BUP) are both approved for opioid use disorder (OUD) treatment in any medical setting. We aimed to compare the real‐world effectiveness of XR‐NTX and SL‐BUP.Design and settingThis was an observational active comparator, new user cohort study of Medicaid claims records for patients in New Jersey and California, USA, 2016–19.Participants/casesThe participants were adult Medicaid patients aged 18–64 years who initiated XR‐NTX or SL‐BUP for maintenance treatment of OUD and did not use medications for OUD in the 90 days before initiation. Our cohort included 1755 XR‐NTX and 9886 SL‐BUP patients.MeasurementsWe examined two outcomes up to 180 days after medication initiation: (1) composite of medication discontinuation and death and (2) composite of overdose and death.FindingsIn adjusted analyses, treatment with XR‐NTX was more likely to result in discontinuation or death by the end of follow‐up than treatment with SL‐BUP: cumulative risk 75.9% [95% confidence interval (CI) = 73.9%, 77.9%] versus 62.2% (95% CI = 61.2%, 63.2%), respectively (risk difference = 13.7 percentage points, 95% CI = 11.4, 16.0). There was minimal difference in the cumulative risk of overdose or death by the end of follow‐up: XR‐NTX 3.9% (95% CI = 3.0%, 4.8%) versus SL‐BUP 3.3% (95% CI = 2.9%, 3.7%); risk difference = 0.5 percentage points, 95% CI = –0.4, 1.5. Results were consistent across sensitivity analyses.ConclusionsMedicaid patients in California and New Jersey, USA, receiving treatment for opioid use disorder stayed in treatment longer on sublingual buprenorphine than on extended‐release naltrexone, but the risk of overdose was similar. Most patients in this study discontinued medication within 6 months, regardless of which medication was initiated.