Jihoon Lim, Julie Bruneau, Robert W Platt, Dimitra Panagiotoglou
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Despite buprenorphine-naloxone (BNX) and methadone (MET) both being first-line OAT options in Canada, their comparative effectiveness in preventing recurrent injection-related infections and poisonings remains unclear.</p><p><strong>Objectives: </strong>This study compared the effectiveness of buprenorphine-naloxone and methadone in reducing recurrent risks of injection-related bacterial infections and opioid-related poisoning among people on OAT.</p><p><strong>Methods: </strong>We used administrative health data from Québec, Canada to create our cohort of adult patients (aged 18-65 years) on OAT maintenance between 2014 and 2019. We applied a time-dependent Cox proportional hazards model for our time-varying exposure definition to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the recurrent risks of injection-related bacterial infections and opioid-related poisoning, adjusting for age, sex, socio-demographic, and clinical factors. We also compared the effectiveness of buprenorphine-naloxone and methadone during the OAT induction phase (i.e., first 30 days of treatment).</p><p><strong>Results: </strong>The study population included 2010 patients (mean age: 41.21 years, 67.41% male). Compared to methadone, buprenorphine-naloxone was associated with 45% lower recurrent risk of opioid-related poisoning (HR: 0.55; 95% CI 0.35-0.86). Overall, the association between buprenorphine-naloxone and recurrent risk of injection-related bacterial infections suggested a weak protective effect (HR: 0.80; 95% CI 0.59-1.09). During the induction phase, there was limited evidence of differences between buprenorphine-naloxone and methadone for the recurrent risks of injection-related bacterial infections (HR: 0.91; 95% CI 0.51-1.60) and opioid-related poisoning (HR: 1.07; 95% CI 0.51-2.24).</p><p><strong>Conclusion: </strong>Among patients in OAT maintenance, buprenorphine-naloxone was associated with lower risk of recurrent opioid-related poisoning compared to methadone, but not for injection-related infections. 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引用次数: 0
摘要
阿片类药物激动剂治疗（OAT）可减少阿片类药物使用障碍（OUD）患者的药物相关中毒和注射相关感染。尽管丁丙诺啡-纳洛酮（BNX）和美沙酮（MET）都是加拿大OAT的一线选择，但它们在预防复发性注射相关感染和中毒方面的相对有效性尚不清楚。目的：本研究比较丁丙诺啡-纳洛酮和美沙酮在降低OAT患者注射相关细菌感染和阿片类药物中毒复发风险方面的有效性。方法：我们使用来自加拿大quacimenbec的行政健康数据，在2014年至2019年期间创建OAT维持的成年患者（18-65岁）队列。我们应用时变暴露定义的时变Cox比例风险模型来估计注射相关细菌感染和阿片类药物相关中毒复发风险的风险比（HR）和95%置信区间（CI），并对年龄、性别、社会人口统计学和临床因素进行调整。我们还比较了丁丙诺啡-纳洛酮和美沙酮在OAT诱导阶段（即治疗的前30天）的有效性。结果：共纳入2010例患者，平均年龄41.21岁，男性占67.41%。与美沙酮相比，丁丙诺啡-纳洛酮与阿片类药物相关中毒复发风险降低45%相关(HR: 0.55；95% ci 0.35-0.86)。总的来说，丁丙诺啡-纳洛酮与注射相关细菌感染复发风险之间的关联表明保护作用较弱(HR: 0.80；95% ci 0.59-1.09)。在诱导期，丁丙诺啡-纳洛酮和美沙酮在注射相关细菌感染复发风险方面存在有限差异(HR: 0.91；95% CI 0.51-1.60)和阿片类药物相关中毒(HR: 1.07；95% ci 0.51-2.24)。结论：在OAT维持的患者中，丁丙诺啡-纳洛酮与美沙酮相比，阿片类药物相关中毒复发的风险较低，但与注射相关感染无关。在诱导过程中没有观察到这种优势，这表明需要在OAT早期改善治疗保留。
The Effect of Opioid Agonist Treatment on Injection-Related Sequelae: A Population-Based Observational Study.
Introduction: Opioid agonist treatment (OAT) reduces drug-related poisonings and injection-related infections among people with opioid use disorder (OUD). Despite buprenorphine-naloxone (BNX) and methadone (MET) both being first-line OAT options in Canada, their comparative effectiveness in preventing recurrent injection-related infections and poisonings remains unclear.
Objectives: This study compared the effectiveness of buprenorphine-naloxone and methadone in reducing recurrent risks of injection-related bacterial infections and opioid-related poisoning among people on OAT.
Methods: We used administrative health data from Québec, Canada to create our cohort of adult patients (aged 18-65 years) on OAT maintenance between 2014 and 2019. We applied a time-dependent Cox proportional hazards model for our time-varying exposure definition to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the recurrent risks of injection-related bacterial infections and opioid-related poisoning, adjusting for age, sex, socio-demographic, and clinical factors. We also compared the effectiveness of buprenorphine-naloxone and methadone during the OAT induction phase (i.e., first 30 days of treatment).
Results: The study population included 2010 patients (mean age: 41.21 years, 67.41% male). Compared to methadone, buprenorphine-naloxone was associated with 45% lower recurrent risk of opioid-related poisoning (HR: 0.55; 95% CI 0.35-0.86). Overall, the association between buprenorphine-naloxone and recurrent risk of injection-related bacterial infections suggested a weak protective effect (HR: 0.80; 95% CI 0.59-1.09). During the induction phase, there was limited evidence of differences between buprenorphine-naloxone and methadone for the recurrent risks of injection-related bacterial infections (HR: 0.91; 95% CI 0.51-1.60) and opioid-related poisoning (HR: 1.07; 95% CI 0.51-2.24).
Conclusion: Among patients in OAT maintenance, buprenorphine-naloxone was associated with lower risk of recurrent opioid-related poisoning compared to methadone, but not for injection-related infections. This advantage was not observed during induction, suggesting the need for improved treatment retention early in OAT.
期刊介绍：
Drug Safety is the official journal of the International Society of Pharmacovigilance. The journal includes:
Overviews of contentious or emerging issues.
Comprehensive narrative reviews that provide an authoritative source of information on epidemiology, clinical features, prevention and management of adverse effects of individual drugs and drug classes.
In-depth benefit-risk assessment of adverse effect and efficacy data for a drug in a defined therapeutic area.
Systematic reviews (with or without meta-analyses) that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement.
Original research articles reporting the results of well-designed studies in disciplines such as pharmacoepidemiology, pharmacovigilance, pharmacology and toxicology, and pharmacogenomics.
Editorials and commentaries on topical issues.
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