2021 AM Posters-Clinical Factors to Guide Clinicians in Selecting Patients Suitable

Clinical Factors to Guide Clinicians in Selecting Patients Suitable - 1

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Opioid use disorder (OUD) is a significant public health issue, and opioid agonist therapy (OAT) is the recommended treatment. Extended-release buprenorphine (BUP-XR) formulations are emerging as options for managing OUD. These include monthly injectable RBP-6000, CAM2038 (weekly or monthly injections), and Probuphine (subdermal implant). These formulations offer advantages such as convenience and reduced risk of diversion, but guidelines on patient selection are lacking.<br /><br />A non-systematic literature review was conducted to determine clinical factors for selecting patients suitable for BUP-XR. The search yielded 289 publications, and 21 were relevant to the study. The selected publications addressed various factors, including incarceration, patient preference, comorbidities, and pregnancy.<br /><br />Regarding incarceration, incarcerated individuals expressed a preference for BUP-XR for managing OUD. One study showed that incarcerated adults maintained on BUP-XR had fewer jail clinic visits and higher treatment retention upon re-entry to the community compared to those on daily buprenorphine.<br /><br />Patient preference studies indicated that individuals perceived benefits of BUP-XR, such as reduced stigma and convenience. However, challenges included lack of prior buprenorphine use, reduced contact with providers, and non-abstinence as a treatment goal. Female patients were more likely to favor BUP-XR compared to males.<br /><br />In the context of comorbidities, limited evidence suggested that BUP-XR may be better suited for certain medical and psychiatric conditions. Case reports indicated that higher maintenance doses of BUP-XR may be necessary for individuals with a history of intravenous opioid use.<br /><br />Regarding pregnancy, case reports described the use of BUP-XR during pregnancy and postpartum, with ongoing randomized controlled trials for CAM2038. However, the use of RBP-6000 BUP-XR is not recommended in pregnancy due to safety concerns related to the chemical additive N-methyl-2-pyrrolidone (NMP).<br /><br />Further research is needed to investigate differences in outcomes between BUP-XR and daily-dosing formulations, the use of BUP-XR in other populations (e.g., geriatric, concurrent disorders, pregnancy), and rapid induction to expand its application in clinical practice.<br /><br />In conclusion, selecting patients suitable for BUP-XR requires consideration of factors such as incarceration, patient preference, comorbidities, and pregnancy. Further research is needed to provide more guidance on patient selection for BUP-XR in the management of OUD.

Keywords

Opioid use disorder

OUD

Opioid agonist therapy

OAT

Extended-release buprenorphine

BUP-XR

RBP-6000

CAM2038

Probuphine

Patient selection

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