Historique
Article de Périodique
Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta-analysis of safety in the mother, fetus and child (2016)
Auteur(s) :
ZEDLER, B. K. ;
MANN, A. L. ;
KIM, M. M. ;
AMICK, H. R. ;
JOYCE, A. R. ;
MURRELLE, E. L. ;
JONES, H. E.
Année :
2016
Page(s) :
2115-2128
Sous-type de document :
Méta-analyse / Meta-analysis ; Revue de la littérature / Literature review
Langue(s) :
Anglais
Refs biblio. :
71
Domaine :
Drogues illicites / Illicit drugs
Thésaurus mots-clés
TRAITEMENT DE MAINTENANCE
;
GROSSESSE
;
BUPRENORPHINE
;
METHADONE
;
COMPARAISON
;
SEXE FEMININ
;
MERE
;
SECURITE
;
FOETUS
;
NOUVEAU-NE
;
PREMATURITE
;
EFFET SECONDAIRE
;
MORTALITE
;
GESTION
;
FACTEUR DE RISQUE
Note générale :
Commentaries:
- Zero is an important number. Smith L., p. 2129-2130.
- The comparative safety of buprenorphine versus methadone in pregnancy - what about confounding? Brogly S.B., Saia K., Hernandez-Diaz S., Werler M., Sebastiani P., p. 2130-2131.
- Response to Smith and Brogly et al. commentaries on Zedler et al. Joyce A.R., Zedler B.K., Amick H.R., Murrelle E.L., Jones H.E., p. 2131-2133.
- Zero is an important number. Smith L., p. 2129-2130.
- The comparative safety of buprenorphine versus methadone in pregnancy - what about confounding? Brogly S.B., Saia K., Hernandez-Diaz S., Werler M., Sebastiani P., p. 2130-2131.
- Response to Smith and Brogly et al. commentaries on Zedler et al. Joyce A.R., Zedler B.K., Amick H.R., Murrelle E.L., Jones H.E., p. 2131-2133.
Résumé :
Aims: To assess the safety of buprenorphine compared with methadone to treat pregnant women with opioid use disorder.
Methods: We searched PubMed, Embase and the Cochrane Library from inception to February 2015 for randomized controlled trials (RCT) and observational cohort studies (OBS) that compared buprenorphine with methadone for treating opioid-dependent pregnant women. Two reviewers assessed independently the titles and abstracts of all search results and full texts of potentially eligible studies reporting original data for maternal/fetal/infant death, preterm birth, fetal growth outcomes, fetal/congenital anomalies, fetal/child neurodevelopment and/or maternal adverse events. We ascertained each study's risk of bias using validated instruments and assessed the strength of evidence for each outcome using established methods. We computed effect sizes using random-effects models for each outcome with two or more studies.
Results: Three RCTs (n = 223) and 15 cohort OBSs (n = 1923) met inclusion criteria. In meta-analyses using unadjusted data and methadone as comparator, buprenorphine was associated with lower risk of preterm birth [RCT risk ratio (RR) = 0.40, 95% confidence interval (CI) = 0.18, 0.91; OBS RR = 0.67, 95% CI = 0.50, 0.90], greater birth weight [RCT weighted mean difference (WMD) = 277 g, 95% CI = 104, 450; OBS WMD = 265 g, 95% CI = 196, 335] and larger head circumference [RCT WMD = 0.90 cm, 95% CI = 0.14, 1.66; OBS WMD = 0.68 cm, 95% CI = 0.41, 0.94]. No treatment differences were observed for spontaneous fetal death, fetal/congenital anomalies and other fetal growth measures, although the power to detect such differences may be inadequate due to small sample sizes.
Conclusions: Moderately strong evidence indicates lower risk of preterm birth, greater birth weight and larger head circumference with buprenorphine treatment of maternal opioid use disorder during pregnancy compared with methadone treatment, and no greater harms.
Methods: We searched PubMed, Embase and the Cochrane Library from inception to February 2015 for randomized controlled trials (RCT) and observational cohort studies (OBS) that compared buprenorphine with methadone for treating opioid-dependent pregnant women. Two reviewers assessed independently the titles and abstracts of all search results and full texts of potentially eligible studies reporting original data for maternal/fetal/infant death, preterm birth, fetal growth outcomes, fetal/congenital anomalies, fetal/child neurodevelopment and/or maternal adverse events. We ascertained each study's risk of bias using validated instruments and assessed the strength of evidence for each outcome using established methods. We computed effect sizes using random-effects models for each outcome with two or more studies.
Results: Three RCTs (n = 223) and 15 cohort OBSs (n = 1923) met inclusion criteria. In meta-analyses using unadjusted data and methadone as comparator, buprenorphine was associated with lower risk of preterm birth [RCT risk ratio (RR) = 0.40, 95% confidence interval (CI) = 0.18, 0.91; OBS RR = 0.67, 95% CI = 0.50, 0.90], greater birth weight [RCT weighted mean difference (WMD) = 277 g, 95% CI = 104, 450; OBS WMD = 265 g, 95% CI = 196, 335] and larger head circumference [RCT WMD = 0.90 cm, 95% CI = 0.14, 1.66; OBS WMD = 0.68 cm, 95% CI = 0.41, 0.94]. No treatment differences were observed for spontaneous fetal death, fetal/congenital anomalies and other fetal growth measures, although the power to detect such differences may be inadequate due to small sample sizes.
Conclusions: Moderately strong evidence indicates lower risk of preterm birth, greater birth weight and larger head circumference with buprenorphine treatment of maternal opioid use disorder during pregnancy compared with methadone treatment, and no greater harms.
Affiliation :
Venebio Group, LLC, Richmond, Virginia, USA
Cote :
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