Extended-release injectable naltrexone for opioid use disorder: a systematic review
Autor: | George E. Bigelow, Shrinidhi Subramaniam, D. Andrew Tompkins, August F. Holtyn, Brantley P. Jarvis, Emmanuel A. Oga, Kenneth Silverman |
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Rok vydání: | 2018 |
Předmět: |
medicine.medical_specialty
Randomization business.industry 030508 substance abuse Medicine (miscellaneous) Opioid use disorder Retrospective cohort study Placebo medicine.disease Naltrexone Heroin 03 medical and health sciences Psychiatry and Mental health 0302 clinical medicine Opioid Internal medicine Medicine 030212 general & internal medicine 0305 other medical science business human activities medicine.drug Buprenorphine |
Zdroj: | Addiction. 113:1188-1209 |
ISSN: | 0965-2140 |
Popis: | Aims To review systematically the published literature on extended-release naltrexone (XR-NTX, Vivitrol® ), marketed as a once-per-month injection product to treat opioid use disorder. We addressed the following questions: (1) how successful is induction on XR-NTX; (2) what are adherence rates to XR-NTX; and (3) does XR-NTX decrease opioid use? Factors associated with these outcomes as well as overdose rates were examined. Methods We searched PubMed and used Google Scholar for forward citation searches of peer-reviewed papers from January 2006 to June 2017. Studies that included individuals seeking treatment for opioid use disorder who were offered XR-NTX were included. Results We identified and included 34 studies. Pooled estimates showed that XR-NTX induction success was lower in studies that included individuals that required opioid detoxification [62.6%, 95% confidence interval (CI) = 54.5-70.0%] compared with studies that included individuals already detoxified from opioids (85.0%, 95% CI = 78.0-90.1%); 44.2% (95% CI = 33.1-55.9%) of individuals took all scheduled injections of XR-NTX, which were usually six or fewer. Adherence was higher in prospective investigational studies (i.e. studies conducted in a research context according to a study protocol) compared to retrospective studies of medical records taken from routine care (6-month rates: 46.7%, 95% CI = 34.5-59.2% versus 10.5%, 95% CI = 4.6-22.4%, respectively). Compared with referral to treatment, XR-NTX reduced opioid use in adults under criminal justice supervision and when administered to inmates before release. XR-NTX reduced opioid use compared with placebo in Russian adults, but this effect was confounded by differential retention between study groups. XR-NTX showed similar efficacy to buprenorphine when randomization occurred after detoxification, but was inferior to buprenorphine when randomization occurred prior to detoxification. Conclusions Many individuals intending to start extended-release naltrexone (XR-NTX) do not and most who do start XR-NTX discontinue treatment prematurely, two factors that limit its clinical utility significantly. XR-NTX appears to decrease opioid use but there are few experimental demonstrations of this effect. |
Databáze: | OpenAIRE |
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