Historique
Article de Périodique
Buprenorphine versus methadone maintenance therapy: a randomized double-blind trial with 405 opioid-dependent patients (2003)
(Traitement de maintenance à la buprénorphine vs. à la méthadone : un essai randomisé en double aveugle auprès de 405 patients dépendants des opioïdes.)
Auteur(s) :
R. P. MATTICK ;
R. ALI ;
J. M. WHITE ;
S. O'BRIEN ;
S. WOLK ;
C. DANZ
Article en page(s) :
441-452
Refs biblio. :
32
Domaine :
Drogues illicites / Illicit drugs
Langue(s) :
Anglais
Thésaurus mots-clés
TRAITEMENT DE MAINTENANCE
;
METHADONE
;
BUPRENORPHINE
;
EFFICACITE
;
COMPARAISON
;
ETUDE TRANSVERSALE
Thésaurus géographique
AUSTRALIE
Résumé :
FRANÇAIS :
La seule différence significative observée entre la buprénorphine et la méthadone, est la capacité de la buprénorphine à induire une meilleure rétention en traitement (10% de patient en plus).
ENGLISH :
AIMS:To assess the efficacy of buprenorphine compared with methadone maintenance therapy for opioid dependence in a large sample using a flexible dosing regime and the marketed buprenorphine tablet. DESIGN: Patients were randomized to receive buprenorphine or methadone over a 13-week treatment period in a double-blind, double-dummy trial. SETTING Three methadone clinics in Australia. PARTICIPANTS: Four hundred and five opioid-dependent patients seeking treatment. INTERVENTION: Patients received buprenorphine or methadone as indicated clinically using a flexible dosage regime. During weeks 1-6, patients were dosed daily. From weeks 7-13, huprenorphine patients received double their week 6 dose on alternate days. MEASUREMENTS: Retention in treatment, and illicit opioid use as determined by urinalysis. Self reported drug use, psychological functioning, HIV risk behaviour, general health and subjective ratings were secondary outcomes. FINDINGS: Intention-to-treat analyses revealed no significant difference in completion rates at 13 weeks. Methadone was superior to buprenorphine in time to termination over the 13-week period (Wald x2 = 4.3 71, df = 1. P = 0.037), but not separately for the single-day or alternate-day dosing phases. There were no significant between-group differences in morphine-positive urines, or in self reported heroin or other Illicit drug use. The majority (85%) of the buprenorphine patients transferred to alternate-day dosing were maintained in alternate-day dosing. CONCLUSIONS: Buprenorphine did not differ from methadone in its ability to suppress heroin use, but retained approximately 70% fewer patients. This poorer retention was due possibly to too-slow induction onto buprenorphine. For the majority of patients, buprenorphine can be administered on alternate days.
La seule différence significative observée entre la buprénorphine et la méthadone, est la capacité de la buprénorphine à induire une meilleure rétention en traitement (10% de patient en plus).
ENGLISH :
AIMS:To assess the efficacy of buprenorphine compared with methadone maintenance therapy for opioid dependence in a large sample using a flexible dosing regime and the marketed buprenorphine tablet. DESIGN: Patients were randomized to receive buprenorphine or methadone over a 13-week treatment period in a double-blind, double-dummy trial. SETTING Three methadone clinics in Australia. PARTICIPANTS: Four hundred and five opioid-dependent patients seeking treatment. INTERVENTION: Patients received buprenorphine or methadone as indicated clinically using a flexible dosage regime. During weeks 1-6, patients were dosed daily. From weeks 7-13, huprenorphine patients received double their week 6 dose on alternate days. MEASUREMENTS: Retention in treatment, and illicit opioid use as determined by urinalysis. Self reported drug use, psychological functioning, HIV risk behaviour, general health and subjective ratings were secondary outcomes. FINDINGS: Intention-to-treat analyses revealed no significant difference in completion rates at 13 weeks. Methadone was superior to buprenorphine in time to termination over the 13-week period (Wald x2 = 4.3 71, df = 1. P = 0.037), but not separately for the single-day or alternate-day dosing phases. There were no significant between-group differences in morphine-positive urines, or in self reported heroin or other Illicit drug use. The majority (85%) of the buprenorphine patients transferred to alternate-day dosing were maintained in alternate-day dosing. CONCLUSIONS: Buprenorphine did not differ from methadone in its ability to suppress heroin use, but retained approximately 70% fewer patients. This poorer retention was due possibly to too-slow induction onto buprenorphine. For the majority of patients, buprenorphine can be administered on alternate days.
Affiliation :
National Drug and Alcohol Research Centre (NDARC), Univ. New South Wales, Sydney, NSW 2052
Australie. Australia.
Australie. Australia.