在临床试验环境中,缓释丁丙诺啡(XR-BUP)不劣于舌下丁丙诺啡,可能具有一定优势.然而,对于高风险人群的低门槛诊所,XR-BUP的实际经验有限,结果未知.在克服治疗挑战方面缺乏实际指导,例如,某些人在XR-BUP之前无法稳定舌下(SL)BUP7天,以及治疗期间持续的渴望/戒断症状。
从2019年2月1日至2019年7月31日,马萨诸塞州总医院桥诊所接受XR-BUP治疗的40例阿片类药物使用障碍(OUD)系列成年人的回顾性病例系列便利样本。
患者多为男性(67.5%),非西班牙裔白人(97.5%),住房不稳定(77.5%),平均年龄32.1岁。XR-BUP之前的平均SLBUP剂量为18.6mg(标准偏差[SD]=5;范围8-32),平均治疗持续时间为105天(SD=191;范围1-810)。10名(25%)患者接受SLBUP的时间少于7个推荐天(平均值=3.7,SD=1.4,范围=1-6)。标准诱导剂量为30%,经验性高剂量XR-BUP(每月300毫克)给药至25%,55%的人接受了4至24mg的补充SLBUP治疗,每天或根据需要,在不同的时间段。在数据收集结束时,XR-BUP保留了65%,30%已停产XR-BUP,一名患者失去随访。继续XR-BUP的患者与停止治疗的患者之间的急性护理使用率相似,分别为18.5%和16.6%,(χ2=0.02,p值=0.89)。在整个治疗过程中,有65%的患者对其他阿片类药物的毒理学阴性。没有用药过量的报告,使用阿片类药物后戒断,或在随后的XR-BUP后沉淀戒断。患者最常引用的停止XR-BUP的原因是偏好SLBUP。
在低阈值诊所中对XR-BUP进行的实际评估发现,治疗是可行的,良好的耐受性,结果很好,大多数人选择继续治疗,大多数人没有持续使用阿片类药物或加速戒断的证据。
In clinical trial settings, extended-release buprenorphine (XR-BUP) is noninferior to sublingual buprenorphine and may offer some advantages. However, real-world experiences of XR-BUP are limited and outcomes are unknown for low-threshold clinics with high-risk populations. Practical guidance is lacking on overcoming treatment challenges, such as inability for some to stabilize on sublingual (SL) BUP for seven days prior to XR-BUP and ongoing craving/withdrawal symptoms during treatment.
Retrospective case series of a convenience sample of 40 serial adults with opioid use disorder (OUD) treated with XR-BUP from Massachusetts General Hospital bridge clinic from February 1, 2019, to July 31, 2019.
Patients were mostly male (67.5%), non-Hispanic white (97.5%), unstably housed (77.5%), and average age of 32.1 years old. The average SL BUP dose prior to XR-BUP was 18.6 mg (standard deviation [SD] = 5; range 8-32) for an average treatment duration of 105 days (SD = 191; range 1-810). Ten (25%) patients received SL BUP for fewer than the seven recommended days (mean = 3.7, SD = 1.4, range = 1-6). Standard induction dosing was administered to 30%, empiric high-dose XR-BUP (300 mg monthly) was administered to 25%, and 55% were treated with supplemental SL BUP ranging from 4 to24mg, daily or as needed, for varying time periods. At the end of data collection, 65% remained on XR-BUP, 30% discontinued XR-BUP, and one patient was lost to follow-up. Acute care utilization rates were similar between patients who continued XR-BUP versus discontinued at 18.5% and 16.6%, respectively (χ2 = 0.02, p-value = 0.89). Toxicology was negative for other opioids in 65% of patients throughout treatment. There were no reports of overdose, withdrawal after use of opioids, or precipitated withdrawal after subsequent XR-BUP. Patients\' most cited reason for discontinuing XR-BUP was a preference for SL BUP.
This real-world evaluation of XR-BUP in a low-threshold clinic found that treatment was feasible, well tolerated, and outcomes were good, with most individuals choosing to continue treatment and a majority with no evidence of ongoing opioid use or precipitated withdrawal.