Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
Drug Alcohol Depend. 2024 Dec 1;265:112470. doi: 10.1016/j.drugalcdep.2024.112470. Epub 2024 Oct 22.
Hospitalizations present an opportunity to initiate naltrexone for patients with alcohol use disorder (AUD). Understanding factors associated with post-hospitalization adherence could inform practice.
This study is a secondary analysis of a clinical trial in which patients with AUD were randomized to oral (PO) versus long-acting injectable (LAI) naltrexone at hospital discharge. The outcome of this secondary analysis was naltrexone adherence 3 months after discharge, defined as receipt of at least 2 out of 3 monthly injections or the equivalent days of self-reported PO medication use (60 out of 90). We used baseline socio-demographics, substance use history, health status, healthcare utilization, and randomization arm to construct multivariable logistic regression models to identify correlates of adherence.
We evaluated patients who initiated naltrexone treatment, 124 randomized to PO and 120 to LAI (overall mean age 49 years, 80 % male, 51 % Black, 47 % unhoused, and 91 % with severe AUD). At 3 months, 50 % of patients were adherent. LAI naltrexone (aOR 3.88; 95 % CI 2.17-7.13), recent office visit (aOR 2.01; 95 % CI 1.10-3.72), and age (aOR per 10-year increase 1.37; 95 % CI 1.02-1.88) were associated with increased odds of adherence. Unhoused status (aOR 0.54; 95 % CI 0.30-0.98) and cocaine use (aOR 0.35; 95 % CI 0.17-0.71) were associated with decreased odds of adherence.
LAI naltrexone for AUD at hospital discharge was associated with better adherence at 3 months vs PO. Access to LAI naltrexone and targeted interventions for patients with cocaine use or who are unhoused hold potential to improve naltrexone adherence.
住院为治疗酒精使用障碍（AUD）的患者提供了使用纳曲酮的机会。了解与住院后依从性相关的因素可以为实践提供信息。
本研究是一项临床试验的二次分析，其中 AUD 患者在出院时被随机分配接受口服（PO）或长效注射（LAI）纳曲酮。本次二次分析的结果是出院后 3 个月的纳曲酮依从性，定义为至少接受 3 次每月注射或等效天数的自我报告 PO 药物使用（90 天中的 60 天）。我们使用基线社会人口统计学、物质使用史、健康状况、医疗保健利用和随机分组臂来构建多变量逻辑回归模型，以确定依从性的相关因素。
我们评估了开始接受纳曲酮治疗的患者，124 名随机分配至 PO 组，120 名随机分配至 LAI 组（总体平均年龄 49 岁，80%为男性，51%为黑人，47%无家可归，91%患有严重 AUD）。在 3 个月时，50%的患者依从。LAI 纳曲酮（优势比 3.88；95%置信区间 2.17-7.13）、最近的门诊就诊（优势比 2.01；95%置信区间 1.10-3.72）和年龄（每增加 10 岁优势比增加 1.37；95%置信区间 1.02-1.88）与增加的依从性几率相关。无家可归状态（优势比 0.54；95%置信区间 0.30-0.98）和可卡因使用（优势比 0.35；95%置信区间 0.17-0.71）与降低的依从性几率相关。
与 PO 相比，出院时使用 LAI 纳曲酮治疗 AUD 与 3 个月时的更好依从性相关。获得 LAI 纳曲酮和针对可卡因使用者或无家可归者的针对性干预措施有可能提高纳曲酮的依从性。
