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Cited by 285Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesPain Management and Opioid Use

Efficacy and safety of a monthly buprenorphine depot injection for opioid use disorder: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial

Haight, Barbara R, Learned, Susan M, Laffont, Celine M, Fudala, Paul J, Zhao, Yue, Garofalo, Amanda S, Greenwald, Mark K, Nadipelli, Vijay R +38 more·2019·The Lancet
DOI 10.1016/s0140-6736(18)32259-1
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Abstract

Background RBP-6000, referred to as BUP-XR (extended-release buprenorphine), is a subcutaneously injected, monthly buprenorphine treatment for opioid use disorder. BUP-XR provides sustained buprenorphine plasma concentrations to block drug-liking of abused opioids over the entire monthly dosing period, while controlling withdrawal and craving symptoms. Administration of BUP-XR in a health-care setting also mitigates abuse, misuse, diversion, and unintentional exposure. We aimed to investigate the efficacy of different BUP-XR dosing regimens in participants with opioid use disorder.Methods This randomised, double-blind, placebo-controlled, phase 3 trial was done at 36 treatment centres in the USA. Treatment-seeking adults aged 18-65 years who had moderate or severe opioid use disorder (as defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders) entered an open-label run-in phase of up to 2 weeks' treatment with buprenorphine-naloxone sublingual film. Eligible participants were then randomly assigned (4:4:1:1) with an interactive voice/web-response system to receive BUP-XR 300 mg/300 mg (six injections of 300 mg), BUP-XR 300 mg/100 mg (two injections of 300 mg plus four injections of 100 mg), or volume-matched placebo every 28 days, and received weekly individual drug counselling. No supplemental buprenorphine was allowed. The primary efficacy endpoint was participants' percentage abstinence from opioid use, defined as the percentage of each participant's negative urine samples and self-reports of illicit opioid use from week 5 to week 24, analysed in the full analysis set. Safety was assessed in all participants who received at least one dose of BUP-XR or placebo. This study is registered with ClinicalTrials.gov, number NCT02357901.Findings From Jan 28, 2015, to Nov 12, 2015, 1187 potential participants were screened, 665 entered run-in, and 504 received BUP-XR 300 mg/300 mg (n=201), BUP-XR 300 mg/100 mg (n=203), or placebo (n=100). Mean participants' percentage abstinence was 41·3% (SD 39·7) for BUP-XR 300 mg/300 mg and 42·7% (38·5) for 300 mg/100 mg, compared with 5·0% (17·0) for placebo (p<0·0001 for both BUP-XR regimens). No compensatory non-opioid drug use was observed during BUP-XR treatment. The most common adverse events were headache (17 [8%] participants in the BUP-XR 300 mg/300 mg group vs 19 [9%] participants in the BUP-XR 300 mg/100 mg group vs six [6%] participants in the placebo group), constipation (16 [8%] vs 19 [9%] vs 0), nausea (16 [8%] vs 18 [9%] vs five [5%]), and injection-site pruritis (19 [9%] vs 13 [6%] vs four [4%]). The BUP-XR safety profile was consistent with other buprenorphine products for treatment of opioid use disorder, except for injection-site reactions, which were reported in more than 5% of all participants who received BUP-XR, but were mostly mild and not treatment-limiting.Interpretation Participants' percentage abstinence was significantly higher in both BUP-XR groups than in the placebo group. Treatment with BUP-XR was also well tolerated. The availability of this monthly formulation, delivered by health-care providers, represents an advance in treatment for opioid use disorder that enhances the benefits of buprenorphine by delivering sustained, optimal exposure, while reducing risks of current buprenorphine products.Funding Indivior.

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Authors
Haight, B. R., Learned, S. M., Laffont, C. M., Fudala, P. J., Zhao, Y., Garofalo, A. S., Greenwald, M. K., Nadipelli, V. R., Ling, W., Heidbreder, C., Andersen, J. L., Bailey, G. L., Bartley, S. R., Biunno, M. J., Boyett, B., Carr, J. M., Cifuentes, E., Duarte-Sckell, S. D., Dueno, O. R., Harrison, B. J., Hassman, D. R., Hoffman, K. S., Isacesu, V., Ishaque, S., Kakar, R., Kampman, K., Knapp, R. D., Konis, G., Kunovac, J., Kwentus, J. A., Levinson, L. S., Malhotra, S., Mehra, V., Mofsen, R. S., Peyton, M. L., Pujari, G. G., Ranjan, R., Rutrick, D., Seal, G., Segal, S. D., Shiwach, R., Thomas, H. M., Ventre, P. P., Vijapura, A. K., Walling, D. P., & Wiest, K. L.
Affiliations
  • Indivior (United States) (US)
  • Wayne State University (US)
  • University of California, Los Angeles (US)
Corresponding author
Greenwald, Mark K
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2019-02
Volume
393
Issue
10173
Pages
778-790
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(18)32259-1
OpenAlex
W2916034192
Cited by
285
References
27
Citations by year
2026: 25 · 2025: 41 · 2024: 31 · 2023: 44 · 2022: 41 · 2021: 38 · 2020: 40 · 2019: 24 · 2013: 1
FWCI
33.32
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords
opioid use disorder, extended-release buprenorphine, opioid abstinence, dosing regimen, drug counselling, treatment-seeking patients, opioid withdrawal, drug diversion, treatment safety, opioid misuse prevention, harm reduction
MeSH terms
Adult, Analgesics, Opioid, Buprenorphine, Dose-Response Relationship, Drug, Double-Blind Method, Drug Administration Schedule, Female, Humans, Injections, Male, Middle Aged, Narcotic Antagonists, Opioid-Related Disorders, Patient Compliance, United States, Patient Satisfaction

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