Buprenorphine associated with shorter therapy, hospitalization for NAS
Buprenorphine therapy among infants whose mothers were unexposed to methadone during pregnancy was associated with shorter durations of treatment and hospitalization compared with methadone in treating neonatal abstinence syndrome, according to study findings.
“This is the first pilot study to report on the use of buprenorphine in clinical practice,” Eric S. Hall, PhD, assistant professor at the Perinatal Institute, Cincinnati Children’s Hospital Medical Center, told Infectious Diseases In Children. “Although oral morphine and methadone have been the mainstay of pharmacotherapy for [neonatal abstinence syndrome (NAS)], buprenorphine may prove to be an alternative for treatment.”
Between 2005 and 2011, more than 14% of women nationwide were prescribed an opioid-based pain reliever at some time during their pregnancies, according to Hall and colleagues. As a result, their newborns may experience withdrawal symptoms, known collectively as NAS. Although a consensus protocol for pharmacotherapy has yet to be determined for NAS, buprenorphine may offer new weaning advantages, Hall said.
“One, it has a ceiling effect for respiratory depression,” he said. “Two, there is limited risk for outpatient misuse. And three, it has a longer half-life than morphine, requiring fewer doses for treatment and therefore fewer opportunities for dosing errors.”
In their retrospective cohort analysis, Hall and colleagues evaluated 201 infants at least 34 weeks’ gestation at birth who received pharmacotherapy for NAS at six Ohio hospitals from January 2012 to August 2014. Infants were treated with oral methadone (n = 163) or sublingual buprenorphine (n = 38), unless the mother had used methadone while pregnant. The researchers determined the duration of treatment and the length of hospitalization for each group. In addition, the researchers examined the use of adjunct therapy as a secondary outcome.
Buprenorphine was associated with a shorter duration of treatment (9.4 days; 95% CI, 7.1-11.7) compared with methadone (14 days; 95% CI, 12.6-15.4). In addition, the researchers wrote that patients assigned buprenorphine had a decreased length of hospitalization (16.3 days; 95% CI, 13.7-18.9) vs. methadone (20.7 days (95% CI, 19.1-22.2). Adjunct therapy use, however, was not significantly different between groups.
The researchers recommended that clinicians match the treatment drug to the drug class that the infant was exposed to in utero. This choice, they said, usually is hospital-dependent.
“One of the most important steps in treating infants with neonatal abstinence syndrome is for clinicians to establish a formal treatment protocol with specified weaning guidelines,” Hall said. “However, this pilot study demonstrates that after treatment has been standardized, there is potentially further opportunity for optimization of outcomes by matching weaning agents with various intrauterine drug exposures.”
The researchers concluded that a large, randomized control trial that examines optimal treatments for NAS is necessary. – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.