Association between dynamic dose increases of buprenorphine for treatment of opioid use disorder and risk of relapse.
Dynamic, adaptive pharmacologic treatment for opioid use disorder (OUD) has been previously recommended over static dosing to prevent relapse, and is aligned with personalized medicine. However, there has been no quantitative evidence demonstrating its advantage. The objective of this study was to estimate the extent to which a hypothetical intervention that increased buprenorphine dose in response to opioid use would affect risk of relapse over 24 weeks of follow-up.
Researchers used data from the buprenorphine arm of CTN-0051 (X:BOT), an open-label randomized controlled 24-week comparative effectiveness trial conducted in 8 community addiction treatment programs in the U.S. 270 participants were included, all of whom were English speaking adults with DSM-5 OUD. Participants were mainly white (65%) and male (72%). In the X:BOT trial, they were treated with daily sublingual buprenorphine-naloxone (BUP-NX), with dose based on clinical indication, determined by the provider. Researchers examined a hypothetical intervention of increasing dose in response to opioid use.
Outcome was relapse to regular opioid use during the 24 weeks of outpatient treatment, assessed in a survival framework. Researchers estimated the relapse-free survival curves of participants under a hypothetical (i.e. counterfactual) intervention in which their BUP-NX dosage would be increased following their own subject-specific opioid use during the first 12 weeks of treatment versus a hypothetical intervention in which dose would remain constant.
After analysis, researchers estimated that increasing BUP-NX dose in response to recent opioid use would lower risk of relapse by 19.17 percentage points and 32%. The number-needed-to-treat with this intervention to prevent a single relapse is 6.
Conclusions: In people with opioid use disorder, a hypothetical intervention that increases sublingual buprenorphine-naloxone dose in response to opioid use during the first 12 weeks of treatment appears to reduce the risk of relapse over 24 weeks, compared with holding the dose constant after week 2.
Related protocols: CTN-0051