Addiction (Abingdon, England) · 2021
Explaining differential effects of medication for opioid use disorder using a novel approach incorporating mediating variables.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Rudolph Kara E, Díaz Iván, Hejazi Nima S, van der Laan Mark J, Luo Sean X, Shulman Matisyahu, Campbell Aimee, Rotrosen John, Nunes Edward V
Аннотация
BACKGROUND AND AIMS: A recent study found that homeless individuals with opioid use disorder (OUD) had a lower risk of relapse on extended-release naltrexone (XR-NTX) versus buprenorphine-naloxone (BUP-NX), whereas non-homeless individuals had a lower risk of relapse on BUP-NX. This secondary study examined differences in mediation pathways to medication effect between homeless and non-homeless participants.
DESIGN: Secondary analysis of an open-label randomized controlled, 24-week comparative effectiveness trial, 2014-17.
SETTING: Eight community addiction treatment programs in the United States.
PARTICIPANTS: English-speaking adults with DSM-5 OUD, recruited during inpatient admission (n = 570).
INTERVENTION(S): Randomization to monthly injection of XR-NTX or daily sublingual BUP-NX.
MEASUREMENTS(S): Mediation analysis estimated the direct effect of XR-NTX versus BUP-NX on relapse and indirect effect through mediators of medication adherence, use of illicit opioids, depressive symptoms and pain, separately by homeless status.
FINDINGS: For the homeless subgroup, the protective indirect path contributed a 3.4 percentage point reduced risk of relapse [95% confidence interval (CI) = -12.0, 5.3] comparing XR-NTX to BUP-NX (explaining 21% of the total effect). For the non-homeless subgroup, the indirect path contributed a 9.4 percentage point increased risk of relapse (95% CI = 3.1, 15.7) comparing XR-NTX to BUP-NX (explaining 57% of the total effect).
CONCLUSIONS: A novel approach to mediation analysis shows that much of the difference in medication effectiveness (extended-release naltrexone versus buprenorphine-naloxone) on opioid relapse among non-homeless adults with opioid use disorder appears to be explained by mediators of adherence, illicit opioid use, depressive symptoms and pain.
DESIGN: Secondary analysis of an open-label randomized controlled, 24-week comparative effectiveness trial, 2014-17.
SETTING: Eight community addiction treatment programs in the United States.
PARTICIPANTS: English-speaking adults with DSM-5 OUD, recruited during inpatient admission (n = 570).
INTERVENTION(S): Randomization to monthly injection of XR-NTX or daily sublingual BUP-NX.
MEASUREMENTS(S): Mediation analysis estimated the direct effect of XR-NTX versus BUP-NX on relapse and indirect effect through mediators of medication adherence, use of illicit opioids, depressive symptoms and pain, separately by homeless status.
FINDINGS: For the homeless subgroup, the protective indirect path contributed a 3.4 percentage point reduced risk of relapse [95% confidence interval (CI) = -12.0, 5.3] comparing XR-NTX to BUP-NX (explaining 21% of the total effect). For the non-homeless subgroup, the indirect path contributed a 9.4 percentage point increased risk of relapse (95% CI = 3.1, 15.7) comparing XR-NTX to BUP-NX (explaining 57% of the total effect).
CONCLUSIONS: A novel approach to mediation analysis shows that much of the difference in medication effectiveness (extended-release naltrexone versus buprenorphine-naloxone) on opioid relapse among non-homeless adults with opioid use disorder appears to be explained by mediators of adherence, illicit opioid use, depressive symptoms and pain.