年轻成年人阿片类使用障碍结局的相关性研究：来自 XBOT 试验的二次分析。
Examination of Correlates of OUD Outcomes in Young Adults: Secondary Analysis From the XBOT Trial.
机构信息
Mountain Manor Treatment Center/Maryland Treatment Centers, Baltimore, Maryland.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
出版信息
Am J Addict. 2021 Sep;30(5):433-444. doi: 10.1111/ajad.13176. Epub 2021 Jun 1.
BACKGROUND AND OBJECTIVES
Opioid use disorder (OUD) treatment outcomes are poorer for young adults than older adults. Developmental differences are broadly implicated, but particular vulnerability factor interactions are poorly understood. This study sought to identify moderators of OUD relapse between age groups.
METHODS
This secondary analysis compared young adults (18-25) to older adults (26+) from a comparative effectiveness trial ("XBOT") that randomized (N = 570) participants to extended-release naltrexone or sublingual buprenorphine-naloxone. We explored the relationship between 25 prespecified patient baseline characteristics and relapse to regular opioid use by age group and treatment condition, using logistic regression.
RESULTS
Young adults (n = 111) had higher rates of 24-week relapse than older adults (n = 459) (70.3% vs 58.8%) and differed on a number of specific characteristics, including more smokers, more intravenous opioid use, and more cannabis use. No significant moderators predicted relapse, in either three-way or two-way interactions.
CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE
No baseline factors were identified as moderating the relationship between age group and opioid relapse, nor any interactions between baseline characteristics, age group, and treatment condition to predict opioid relapse. Poorer treatment outcomes for young adults are likely associated with multiple developmental vulnerabilities rather than any single predominant factor. Although not reaching significance, several characteristics (using heroin, smoking tobacco, high levels of depression/anxiety, or treatment because of family/friends) showed higher odds ratio point estimates for relapse in young adults than older adults. This is the first study to explore moderators of worse OUD treatment outcomes in young adults, highlighting the need to identify predictor variables that could inform treatment enhancements. (Am J Addict 2021;00:1-12).
背景与目的
阿片类药物使用障碍（OUD）的治疗结果在年轻人中比在老年人中更差。广泛涉及到发育差异，但对特定的脆弱性因素相互作用了解甚少。本研究旨在确定年龄组之间 OUD 复发的调节因素。
方法
这项二次分析比较了来自一项比较有效性试验（“XBOT”）的年轻成年人（18-25 岁）和老年成年人（26+岁），该试验将参与者随机分为缓释纳曲酮或舌下丁丙诺啡-纳洛酮。我们使用逻辑回归探索了 25 个预设的患者基线特征与年龄组和治疗条件下复发的关系。
结果
年轻成年人（n=111）在 24 周时的复发率高于老年成年人（n=459）（70.3% vs. 58.8%），并且在许多特定特征上存在差异，包括更多的吸烟者、更多的静脉内阿片类药物使用和更多的大麻使用。没有显著的调节因素预测复发，无论是在三向还是双向相互作用中。
结论和科学意义
没有发现基线因素可以调节年龄组和阿片类药物复发之间的关系，也没有任何基线特征、年龄组和治疗条件之间的相互作用来预测阿片类药物复发。年轻成年人的治疗结果较差可能与多种发育脆弱性有关，而不是任何单一的主要因素。尽管没有达到显著性，但一些特征（使用海洛因、吸烟、高水平的抑郁/焦虑或因家人/朋友而接受治疗）在年轻成年人中显示出比老年成年人更高的复发比值比点估计值。这是第一项探索年轻成年人 OUD 治疗结果较差的调节因素的研究，强调需要确定可告知治疗增强的预测变量。（美国成瘾杂志 2021；00:1-12）。
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