In an invited commentary published in JAMA Network Open, researchers from the National Institute on Drug Abuse stated extended-release (ER) formulations of buprenorphine have the potential to help effectively combat the opioid crisis in the US, as patients reported high satisfaction.
To reduce the number of overdose deaths in the United States, which in 2019 was >70,000, an expansion of opioid use disorder (OUD) treatments is needed.
The challenges for OUD treatment include low retention rates, in which 40% to 50% of patients have a relapse within 6 months. In other areas of medicine, ER formulations have been found to increase treatment compliance, and ER formulations may be more useful among patients who are homeless or reside in rural areas where access to OUD treatments is limited.
ER naltrexone and buprenorphine have been found to be as efficacious as immediate-release (IR) formulations during clinical trials. If IR and ER formulations are similarly efficacious for the treatment of OUD, which drug is superior? The commentary authors emphasized that the patient’s perspective and preference should be an important factor to consider to determine which formulation may be more effective.
For example, a recent study of weekly or monthly ER buprenorphine compared with daily oral buprenorphine for the treatment of OUD used patient-reported outcomes as the primary outcome and compliance and retention as secondary outcomes.
This study found no difficulty in transitioning from the oral to ER formulation, and patients reported they were more satisfied with the ER formulations. The ER formulation was both well tolerated and acceptable to patients.
The commentary authors congratulated the researchers who performed this study, noting that their choice to focus on the patient perspectives was an innovative strategy. However, it remains unclear whether their study findings may be generalizable to other regions (outside Australia) due to differing standards of practice.
Researchers were urged to consider elevating the importance of patient-reported outcomes in the design of OUD treatment studies because even if the studied drugs are similarly efficacious, patient satisfaction may be the determining factor for which treatment would be more effective in the real-world setting. Increased patient satisfaction and compliance with ER formulations have the potential to reduce overdose mortality and help combat the opioid epidemic.
Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of authors’ disclosures.
Comptom W M, Volkow N D. Extended-release buprenorphine and its evaluation with patient-reported outcomes. JAMA Netw Open. 2021;4(5):e219708. doi:10.1001/jamanetworkopen.2021.9708