2014年至2021年美国多付款人国家样本中16毫克以上丁丙诺啡剂量与治疗保留之间的关系。

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2025-02-24 DOI:10.1111/add.70002

Erin J. Stringfellow, Huiru Dong, Seyedeh Nazanin Khatami, Hannah Lee, Mohammad S. Jalali

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引用次数: 0

摘要

背景和目的：丁丙诺啡-纳洛酮可减少阿片类药物使用障碍（OUD）患者的过量死亡。每日剂量越高，治疗效果越好。目前还没有全国性的关于24、32和40 mg的保留率的研究。本研究旨在：(1)评估4 - 40 mg丁丙诺啡-纳洛酮剂量与16 mg丁丙诺啡-纳洛酮剂量对治疗保留力的影响；(2)比较24、32、40 mg剂量对治疗滞留的影响。设计：在涉及丁丙诺啡-纳洛酮治疗OUD发作的处方索赔（IQVIA）的全国性多付款人样本中进行观察性队列研究。事件发生于2014年1月1日至2020年3月31日之间，其间有180天的间歇期。新发作开始时，处方间隔超过14天。背景：美利坚合众国。参与者：样本涉及498 879例患者的620 229次发作[42.3%为女性；平均年龄37.9（标准差：11.9）]，处方丁丙诺啡-纳洛酮治疗OUD。测量：暴露量是在发作的前30天达到的丁丙诺啡-纳洛酮的最大日剂量，范围从4到40毫克。结果，治疗保留，被定义为在1、3、6、12或18个月有有效处方。协变量为年龄、性别、种族和民族、主要付款人和发病开始年份。结果：与16 mg相比，每日剂量24,32和40mg在1-18个月时增加了潴留[调整优势比（aOR）范围= 1.17；95%可信区间(CI) = 1.14, 18个月时为1.20,1个月时为1.52 (CI = 1.49, 1.54)，均为24 mg]。在两两比较中，6个月时32 mg优于24 mg [aOR = 1.06 (95% CI = 1.02, 1.10)；12个月时aOR = 1.09 (95% CI = 1.04, 1.14)；18个月时aOR = 1.12 (95% CI = 1.06, 1.19)， 12个月和18个月时40 mg优于24 mg[12个月时aOR = 1.10 (95% CI = 1.01, 1.21)；18个月时aOR = 1.18 （95% CI = 1.06, 1.30）。结论：每日剂量24mg的丁丙诺啡-纳洛酮与16mg相比，似乎与增加的治疗滞留有关；对于6个月以上的发作，32mg和40mg与24mg相比，似乎与增加的滞留有关。

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The association between buprenorphine doses above 16 milligrams and treatment retention in a multi-payer national sample in the United States, 2014 to 2021

Background and Aims

Buprenorphine-naloxone reduces overdose deaths in people with opioid use disorder (OUD). Treatment retention increases with higher daily doses. No national studies exist on retention's association with 24, 32 and 40 mg. This study aimed to: (1) estimate the effect on treatment retention of buprenorphine-naloxone doses between 4 and 40 mg compared with 16; and (2) compare the effect on treatment retention of 24, 32 and 40 mg doses.

Design

Observational cohort study in a national, multi-payer sample of prescription claims (IQVIA) of episodes involving buprenorphine-naloxone for OUD. Incident episodes started between 1 January 2014 and 31 March 2020, with a washout of 180 days. New episodes started with a 14+ day gap between prescriptions.

Setting

United States of America.

Participants

The sample involved 620 229 episodes across 498 879 patients [42.3% female; mean age 37.9 (standard deviaion: 11.9)] who were dispensed prescriptions of buprenorphine-naloxone for OUD.

Measurements

The exposure was the maximum daily dose of buprenorphine-naloxone reached in the first 30 days of an episode, ranging from 4 to 40 mg. The outcome, treatment retention, was defined as having an active prescription at 1, 3, 6, 12, or 18 months. Covariates were age, sex, race and ethnicity, primary payer, and year of episode initiation.

Findings

Daily doses of 24, 32 and 40 mg increased retention compared with 16 mg at 1–18 months [adjusted odds ratio (aOR) range = 1.17; 95% confidence interval (CI) = 1.14, 1.20 at 18 months to 1.52 (CI = 1.49, 1.54) at 1 month, both for 24 mg]. In pairwise comparisons, 32 mg was favorable to 24 mg at 6, 12 and 18 months [aOR = 1.06 (95% CI = 1.02, 1.10) at 6 months; aOR = 1.09 (95% CI = 1.04, 1.14) at 12 months; aOR = 1.12 (95% CI = 1.06, 1.19) at 18 months], and 40 mg was favorable to 24 mg at 12 and 18 months [aOR = 1.10 (95% CI = 1.01, 1.21) at 12 months; aOR = 1.18 (95% CI = 1.06, 1.30) at 18 months].

Conclusions

Daily buprenorphine-naloxone doses of 24 mg appear to be associated with increased treatment retention compared with 16 mg and, for 6+ month episodes, 32 and 40 mg appear to be associated with increased retention compared with 24 mg.

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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.