缓释丁丙诺啡的起始和剂量:芬太尼患者新方法的叙述性回顾。

IF 5.1 Q1 SUBSTANCE ABUSE
Substance Abuse and Rehabilitation Pub Date : 2025-03-25 eCollection Date: 2025-01-01 DOI:10.2147/SAR.S516138
Kenneth W Lee, Annabel Mead, Imran Ghauri, Bruce Hollett, Martine Drolet, Jan-Marie Kozicky
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引用次数: 0

摘要

使用芬太尼的阿片类药物使用障碍(OUD)患者由于阿片类药物过量而死亡的风险很高。虽然丁丙诺啡缓释(BUP-XR)可以降低这种风险,但有必要优化BUP-XR的临床实践,以克服芬太尼患者开始和保持治疗的障碍。通过对同行评审出版物和会议摘要证据的叙述性回顾,本文概述了目前在确认或推测使用芬太尼的患者群体中使用BUP-XR的新起始和剂量策略。这一领域的证据正在迅速涌现,多项研究描述了BUP-XR在经黏膜丁丙诺啡(TM-BUP) 7天稳定之前开始。一项随机对照研究的结果表明,单次TM-BUP剂量后启动BUP-XR在注射2次时的治疗保留性方面不低于标准启动,具有相似的沉淀停药率和不良事件,该方案现已列入美国批准的处方信息中。虽然也报告了其他“大剂量/高剂量”或“微剂量/低剂量”和“直接剂量”诱导方法,但这些方法的证据仅限于小型非对照研究或病例报告。来自TM-BUP研究的证据表明,使用芬太尼的个体可能需要更高的维持剂量才能继续治疗,与此一致的是,管理和观察数据表明,使用300毫克维持剂量、缩短剂量间隔和补充TM-BUP可能是增加持续症状患者丁丙诺啡暴露和改善保留的可行方法。这一领域的证据正在迅速发展,其中许多策略越来越多地被临床采用并纳入临床指南。进一步的研究应包括增加样本量,更广泛和更一致的结果测量,并增加随访时间,以促进更可靠的疗效和安全性评估,并增加研究之间的可比性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Initiation and Dosing of Extended-Release Buprenorphine: A Narrative Review of Emerging Approaches for Patients Who Use Fentanyl.

Individuals with Opioid Use Disorder (OUD) who use fentanyl are at high risk of mortality due to opioid-related overdose. While buprenorphine extended-release (BUP-XR) may reduce this risk, there is a need to optimize clinical practice with BUP-XR to overcome barriers to treatment initiation and retention in patients who use fentanyl. Through a narrative review of evidence from peer-reviewed publications and conference abstracts, this article provides an overview of current novel initiation and dosing strategies for BUP-XR in patient populations with confirmed or presumed use of fentanyl. Evidence in this area is rapidly emerging with multiple studies describing BUP-XR initiation prior to 7-day stabilization on transmucosal buprenorphine (TM-BUP). Results from a randomized controlled study indicate that initiating BUP-XR following a single TM-BUP dose is noninferior to standard initiation in terms of treatment retention at injection 2, with similar rates of precipitated withdrawal and adverse events, and this protocol is now included in the approved prescribing information in the USA. While additional "macro/high-dose" or "micro/low-dose" and "direct dose" induction approaches have also been reported, evidence for these is limited to small uncontrolled studies or case reports. Consistent with evidence from studies of TM-BUP, which suggests individuals who use fentanyl may require higher maintenance doses in order to be retained in treatment, administrative and observational data suggests that use of the 300-mg maintenance dose, shortened intervals between doses, and supplemental TM-BUP may be feasible approaches to increase buprenorphine exposure in patients with ongoing symptoms and improve retention. Evidence in this area is rapidly evolving, and many of these strategies are increasingly being adopted clinically and incorporated into clinical guidelines. Further research should incorporate increased sample sizes, broader and more consistent outcome measurement, and increased duration of follow-up to facilitate more robust evaluation of efficacy and safety as well as increase comparability between studies.

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