Relative risks of adverse effects across different opioid agonist treatments—A systematic review and meta-analysis

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2025-02-09 DOI:10.1111/add.70000

Maximilian Meyer, Eriks Strazdins, Adrian Guessoum, Jean N. Westenberg, Christian Appenzeller-Herzog, Marco E. G. V. Cattaneo, R. Michael Krausz, Kenneth M. Dürsteler, Undine E. Lang, Lars G. Hemkens, Marc Vogel

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Abstract

Background and Aims

Opioid agonist treatment (OAT) is established for opioid use disorder, but limited data on adverse effects exist. We aimed to review relative risks of adverse effects across opioid agonists.

Methods

Systematic review with pair-wise meta-analysis of randomized clinical trials. A search in Embase, Medline, PsycInfo, CENTRAL and the Web of Science Core Collection was performed from inception to 11 April 2024 (PROSPERO: CRD42022322722). Two reviewers independently extracted data and used the Cochrane Risk of Bias Assessment Tool. Certainty of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Primary outcomes were constipation, sedation, pruritus, sweating, nausea and vomiting, headache and any non-headache pain.

Results

We identified 25 eligible trials, including 4892 participants. Reported agonists were methadone, levomethadone, methadyl acetate, buprenorphine, buprenorphine/naloxone, slow-release oral morphine (SROM), diacetylmorphine, hydromorphone and opium tincture. Buprenorphine (all formulations combined) was associated with a lower risk of sedation than methadone [risk ratio (RR) = 0.68 (95% confidence interval = 0.56–0.82)]; 1558 participants, 9 studies]. Methadone had a lower risk of sedation compared with SROM [RR = 0.63 (0.58–0.69); 356 participants, 2 studies] and a lower risk of nausea than methadyl acetate [RR = 0.56 (0.37–0.85); 913 participants, 3 studies]. There was high overall risk of bias in 92% of included trials due to limited and non-systematic outcome assessment. Certainty of evidence was low or very low for all but one comparison with moderate certainty.

Conclusions

There is currently insufficient data to determine whether the rates of adverse effects differ across opioid agonist treatments for most outcomes, with several exceptions. Moreover, the certainty of evidence is currently low or very low due to a lack of rigorous outcome assessment.

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不同阿片类激动剂治疗不良反应的相对风险-系统回顾和荟萃分析。

背景和目的：阿片类药物激动剂治疗（OAT）是针对阿片类药物使用障碍建立的，但关于不良反应的数据有限。我们的目的是回顾阿片类激动剂不良反应的相对风险。方法：采用随机临床试验的双元分析进行系统评价。检索Embase， Medline, PsycInfo， CENTRAL和Web of Science Core Collection从成立到2024年4月11日（PROSPERO: CRD42022322722）。两位审稿人独立提取数据并使用Cochrane偏倚风险评估工具。使用GRADE（建议评估、发展和评价分级）评估证据的确定性。主要结局为便秘、镇静、瘙痒、出汗、恶心和呕吐、头痛和任何非头痛性疼痛。结果：我们确定了25项符合条件的试验，包括4892名受试者。报道的激动剂有美沙酮、左美沙酮、醋酸甲胺醇、丁丙诺啡、丁丙诺啡/纳洛酮、口服吗啡缓释（rom）、二乙酰吗啡、氢吗啡酮和鸦片酊。丁丙诺啡（所有制剂组合）镇静风险低于美沙酮[风险比(RR) = 0.68(95%可信区间= 0.56-0.82)]；1558名参与者，9项研究]。美沙酮与SROM相比镇静风险较低[RR = 0.63 (0.58-0.69)；356名受试者，2项研究]，恶心风险低于醋酸甲酯[RR = 0.56 (0.37-0.85)；913名受试者，3项研究]。由于有限和非系统的结果评估，92%的纳入试验存在高偏倚风险。除了一个具有中等确定性的比较外，所有证据的确定性都很低或非常低。结论：目前没有足够的数据来确定阿片类激动剂治疗对大多数结果的不良反应率是否不同，但有几个例外。此外，由于缺乏严格的结果评估，证据的确定性目前很低或非常低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.