Comparative effectiveness of extended-release naltrexone and sublingual buprenorphine for treatment of opioid use disorder among Medicaid patients

被引:3
作者
Ross, Rachael K. [1 ]
Nunes, Edward V. [2 ,3 ]
Olfson, Mark [1 ,2 ,3 ]
Shulman, Matisyahu [2 ,3 ]
Krawczyk, Noa [4 ]
Stuart, Elizabeth A. [5 ]
Rudolph, Kara E. [1 ]
机构
[1] Columbia Univ, Mailman Sch Publ Hlth, Dept Epidemiol, 722 168th St, New York, NY 10032 USA
[2] Columbia Univ, Irving Med Ctr, Dept Psychiat, New York, NY USA
[3] New York State Psychiat Inst & Hosp, New York, NY USA
[4] NYU Langone Hlth, Dept Populat Hlth, New York, NY USA
[5] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Biostat, Baltimore, MD USA
基金
美国国家卫生研究院;
关键词
Extended-release naltrexone; Medicaid; opioid use disorder; overdose; sublingual buprenorphine; treatment retention; XBOT; DISCONTINUATION; OVERDOSE; NALOXONE;
D O I
10.1111/add.16630
中图分类号
R194 [卫生标准、卫生检查、医药管理];
学科分类号
摘要
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.
引用
收藏
页码:1975 / 1986
页数:12
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