Historique
Article de Périodique
Extended-release naltrexone versus oral naltrexone for substance use disorders: A systematic review and meta-analysis (2025)
Auteur(s) :
ELMOSALAMY, A. ;
SIROHI, A. ;
MOUSTAFA, A. ;
MASOUD, O. ;
HASSETT, L. C. ;
KOLLA, B. P. ;
SINGH, B.
Année
2025
Page(s) :
art. 112789
Sous-type de document :
Revue de la littérature / Literature review
Langue(s) :
Anglais
Domaine :
Alcool / Alcohol ; Autres substances / Other substances ; Drogues illicites / Illicit drugs
Thésaurus mots-clés
NALTREXONE
;
COMPARAISON
;
VOIE D'ADMINISTRATION
;
ALCOOL
;
OPIOIDES
;
TRAITEMENT
Résumé :
Purpose: This systematic review and meta-analysis aimed to compare extended-release naltrexone (XR-NTX) and oral naltrexone (NTX) for treating substance use disorders (SUDs).
Methods: A comprehensive search of multiple databases (MEDLINE, Embase, Cochrane, APA PsycInfo, and Scopus) was conducted on October 1, 2024, with no date or language restrictions. Inclusion criteria were adults with SUDs, interventions with XR-NTX, comparisons with oral NTX, and outcomes on treatment persistence, hospitalizations, and emergency department (ED) visits. Randomized controlled trials (RCTs) and observational studies were included. Odds ratios were calculated using the Mantel-Haenszel random-effects model.
Results: Of the 1116 studies screened, 27 were selected for full-text review, 15 met the inclusion criteria (3 open-label RCTs [n = 340] and 12 retrospective studies [n = 18,695]) focusing on alcohol use disorder (AUD) and opioid use disorder (OUD), and 7 were included in the meta-analysis. We found no other SUD where the two interventions were compared. Treatment persistence was significantly higher with XR-NTX compared to oral NTX at both 3 months (OR 1.43 [95% CI: 1.04-1.96], p = 0.03) and 6 months (OR 1.96 [95% CI: 1.37-2.81], p = 0.0002). No significant differences were observed in healthcare utilization, including inpatient admissions (OR 0.69 [95% CI: 0.30-1.61], p = 0.39) or ED visits (OR 1.17 [95% CI: 0.61-2.26], p = 0.63).
Conclusions: Patients with AUD and OUD receiving XR-NTX stay in treatment longer than those receiving oral NTX. However, hospitalization and ED visit rates did not differ. Findings are limited due to a small number of RCTs. [Author's abstract]
Highlights:
Reviewed 15 studies comparing oral vs. extended-release NTX for SUD Treatment.
Aimed to assess all SUDs but found data only on AUD and OUD.
XR-NTX showed higher persistence at 3 and 6 months than oral NTX.
Hospital admissions and ED visits were similar for both treatments.
Despite higher XR-NTX drug costs, overall treatment costs were similar.
Methods: A comprehensive search of multiple databases (MEDLINE, Embase, Cochrane, APA PsycInfo, and Scopus) was conducted on October 1, 2024, with no date or language restrictions. Inclusion criteria were adults with SUDs, interventions with XR-NTX, comparisons with oral NTX, and outcomes on treatment persistence, hospitalizations, and emergency department (ED) visits. Randomized controlled trials (RCTs) and observational studies were included. Odds ratios were calculated using the Mantel-Haenszel random-effects model.
Results: Of the 1116 studies screened, 27 were selected for full-text review, 15 met the inclusion criteria (3 open-label RCTs [n = 340] and 12 retrospective studies [n = 18,695]) focusing on alcohol use disorder (AUD) and opioid use disorder (OUD), and 7 were included in the meta-analysis. We found no other SUD where the two interventions were compared. Treatment persistence was significantly higher with XR-NTX compared to oral NTX at both 3 months (OR 1.43 [95% CI: 1.04-1.96], p = 0.03) and 6 months (OR 1.96 [95% CI: 1.37-2.81], p = 0.0002). No significant differences were observed in healthcare utilization, including inpatient admissions (OR 0.69 [95% CI: 0.30-1.61], p = 0.39) or ED visits (OR 1.17 [95% CI: 0.61-2.26], p = 0.63).
Conclusions: Patients with AUD and OUD receiving XR-NTX stay in treatment longer than those receiving oral NTX. However, hospitalization and ED visit rates did not differ. Findings are limited due to a small number of RCTs. [Author's abstract]
Highlights:
Reviewed 15 studies comparing oral vs. extended-release NTX for SUD Treatment.
Aimed to assess all SUDs but found data only on AUD and OUD.
XR-NTX showed higher persistence at 3 and 6 months than oral NTX.
Hospital admissions and ED visits were similar for both treatments.
Despite higher XR-NTX drug costs, overall treatment costs were similar.
Affiliation :
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
Department of Internal Medicine, Anne Arundel Medical Center, Annapolis, MD, USA
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
Royal Free London NHS Foundation Trust, United Kingdom
Mayo Clinic Libraries, Rochester, MN, USA
Department of Internal Medicine, Anne Arundel Medical Center, Annapolis, MD, USA
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
Royal Free London NHS Foundation Trust, United Kingdom
Mayo Clinic Libraries, Rochester, MN, USA