Naltrexone vs Buprenorphine: Which is Best for Preventing Opioid Relapse?

Extended-release naltrexone (XR-NTX) and buprenorphine/naloxone (BUP-NX) were similarly effective in preventing relapse in patients with opioid use disorder, according to the results of a recent study.

In order to compare the effectiveness of XR-NTX and BUP-NTX, researchers conducted a 24-week, open-label, randomized controlled, comparative effectiveness trial at 8 US community-based inpatient services. All 570 participants were 18 years or older, had DSM-5 opioid use disorder, and had used non-prescribed opioids within 30 days. XR-NTX was administered as monthly intramuscular injections and BUP-NX was daily self-administered as sublingual film.
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Overall, fewer participants successfully initiated XR-NTX (72%) than BUP-NX (94%), and 24-week relapse events were greater for those taking XR-NTX (65%) than BUP-NX (57%). Most of this difference was accounted for by early relapse in nearly all XR-NTX induction failures.

Among those participants successfully inducted, 24-week relapse events were similar across the study groups, with opioid-negative urine samples and opioid-abstinent days favoring BUP-NX among the intention-to-treat population, but similar results among the per-protocol population.

Excluding injection site reactions, adverse events were similar between the groups.

“In this population it is more difficult to initiate patients to XR-NTX than BUP-NX, and this negatively affected overall relapse. However, once initiated, both medications were equally safe and effective. Future work should focus on facilitating induction to XR-NTX and on improving treatment retention for both medications.”

—Michael Potts

Reference:

Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial [published online November 14, 2017]. Lee JD, Nunes EV, Novo P, et al. Lancet. doi: http://dx.doi.org/10.1016/S0140-6736(17)32812-X.