Barnett P G, Rodgers J H, Bloch D A
Cooperative Studies Program and Health Economics Resource Center, VA Palo Alto Health Care System, US Department of Veterans Affairs, Menlo Park, CA 94025, USA.
Addiction. 2001 May;96(5):683-90. doi: 10.1046/j.1360-0443.2001.9656834.x.
The unique pharmacological properties of buprenorphine may make it a useful maintenance therapy for opiate addiction. This meta-analysis considers the effectiveness of buprenorphine relative to methadone.
A systematic literature search identified five randomized clinical trials comparing buprenorphine to methadone. Data from these trials were obtained. Retention in treatment was analyzed with a Cox proportional hazards regression. Urinalyses for opiates were studied with analysis of variance and a common method of handling missing values. A meta-analysis was used to combine these results.
Subjects who received 8-12 mg/day buprenorphine had 1.26 times the relative risk of discontinuing treatment (95% confidence interval 1.01-1.57) and 8.3% more positive urinalyses (95% confidence interval 2.7-14%) than subjects receiving 50-80 mg/day methadone. Buprenophrine was more effective than 20-35 mg/day methadone. There was substantial variation in outcomes in the different trials.
The variation between trials may be due to differences in dose levels, patient exclusion criteria and provision of psychosocial treatment. The difference in the effectiveness of buprenorphine and methadone may be statistically significant, but the differences are small compared to the wide variance in outcomes achieved in different methadone treatment programs. Further research is needed to determine if buprenorphine treatment is more effective than methadone in particular settings or in particular subgroups of patients.
丁丙诺啡独特的药理特性可能使其成为治疗阿片类成瘾的一种有用的维持疗法。本荟萃分析比较了丁丙诺啡与美沙酮的疗效。
通过系统的文献检索，确定了五项比较丁丙诺啡与美沙酮的随机临床试验。获取了这些试验的数据。采用Cox比例风险回归分析治疗保留率。使用方差分析和一种处理缺失值的常用方法研究阿片类药物的尿液分析。采用荟萃分析合并这些结果。
与接受每日50 - 80毫克美沙酮的受试者相比，接受每日8 - 12毫克丁丙诺啡的受试者停药的相对风险高1.26倍（95%置信区间1.01 - 1.57），尿液分析呈阳性的比例高8.3%（95%置信区间2.7 - 14%）。丁丙诺啡比每日20 - 35毫克美沙酮更有效。不同试验的结果存在很大差异。
试验之间的差异可能是由于剂量水平、患者排除标准和心理社会治疗的提供方式不同所致。丁丙诺啡和美沙酮疗效的差异可能具有统计学意义，但与不同美沙酮治疗项目所取得的结果的广泛差异相比，这些差异较小。需要进一步研究以确定在特定环境或特定患者亚组中，丁丙诺啡治疗是否比美沙酮更有效。
