Naltrexone Noninferior to Buprenorphine-Naloxone
Extended-release naltrexone was as effective as buprenorphine-naloxone for maintaining short-term abstinence from heroin or opioids among individuals dependent on opioids, according to a recent study. The treatment was and researchers suggested it should be considered an option for opioid use therapy.
In the outpatient, open-label randomized clinical trial, researchers recruited 159 participants dependent on opioids and enrolled in 5 urban addiction clinics in Norway between November 1, 2012 and December 23, 2015 (mean age 36 years, 44 participants were women). Participants were randomly assigned to either 4 to 24 mg of oral buprenorphine-naloxone per day (n= 79) or 380 mg of extended-release naltrexone hydrochloride administered intramuscularly every 4 weeks (n=80) for 12 weeks.
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Outcomes included the randomized clinical trial completion rate, proportion of opioid-negative urine drug tests, and number of days of heroin or other illicit opioid use, as well as the number of days of other illicit substance use.
A total of 105 participants (66%) completed the trial. The retention of participants in the extended-release naltrexone group was noninferior to the retention in the buprenorphine-naloxone group, with the mean time of 69.3 days and 63.7 days, respectively.
Likewise, the group proportion of the total number of opioid-negative urine drug tests among participants in the extended-release naltrexone group was noninferior to those in the buprenorphine-naloxone group. Extended-release naltrexone was noninferior to buprenorphine-naloxone for use of heroin or other illicit opioids, and had significantly lower heroin or other illicit opioid use in superiority analysis.
However, the researchers did not find any significant differences in treatment groups for other illicit substance use.
“Maintaining short-term opioid abstinence with extended-release naltrexone should be considered an equal treatment alternative to buprenorphine-naloxone as medication-assisted treatment for opioid-dependent individuals,” the researchers concluded.
—Melissa Weiss
Reference:
Tanum L, Solli KK, Latif Z, et al. The effectiveness of injectable extended-release naltrexone vs daily buprenorphine-naloxone for opioid dependence: a randomized clinical noninferiority trial [published online October 18, 2017]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.3206.