USE OF OPIOID ANTAGONIST NALTREXONE TO TREAT OPIOID ... · NALTREXONE TO TREAT OPIOID ADDICTION IN...
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USE OF OPIOID ANTAGONIST NALTREXONE TO TREAT OPIOID
ADDICTION IN RUSSIAElena Blokhina, MD, PhD
First Pavlov State Medical University
Saint Petersburg, Russia
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Background
■ Russian Federation develops a treatment approach for
people with opioid use disorder (OUD) to improve
treatment adherence and decrease frequency of relapse
■ Hepatitis, HIV and TB co-infection is common among
patients with opioid dependence
■ Untreated opioid addiction in HIV positive patients is
associated with poor ART adherence and outcome
■ Extended release naltrexone is effective for OUD and
might also help improve HIV treatment outcomes
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1 ORAL NALTREXONE
2 NALTREXONE IMPLANT
PRODETOXON®
3INJECTABLE
NALTREXONE
VIVITROL®
Naltrexone formulations:
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Retention in addiction treatment:
Kaplan-Meier Analysis of Time-to-Discontinuation
Median days
of treatment
Median days on treatment was significantly longer for patients in the XR-NTX vs.
placebo group: >168 days vs. 96 days in the placebo group (P=0.0042)
INJE
CTIO
N
Krupitsky et al., Lancet, 2011
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7,7
0,7
4,4
3,7
7,2
1,9
4,0
3,3
0,0
1,0
2,0
3,0
4,0
5,0
6,0
7,0
8,0M
ea
n R
AB
sco
res
XR-NTX (N=126/71)
Placebo (N=124/65)
Baseline Week 24
HIV Risk Assessment Battery (RAB):
Baseline and LOCF-endpoint Scores
*
* P=0.006
P-value based on Van der Waerden test for XR-NTX vs. Placebo
Le
ss r
isk
y b
eh
avio
r
RAB: Drug Risk RAB: Sex Risk
Baseline Week 24
INJE
CTIO
N
Krupitsky et al., Lancet, 2011
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0 4 8 12 16 20 24 28 32 36 40 44 48
0
10
20
30
40
50
60
70
80
90
100
T im e , w e e k s
Pe
rce
nt
su
rviv
al
in a
dd
icti
on
tre
atm
en
t O N g r o u p
N I g r o u p
IMP
LA
NT
Weeks in addiction treatment among patients
stabilized on oral or implantable naltrexone
More NI than ON participants completed addiction treatment 32 (32%)
vs. 17 (17%); Fisher Exact Test p=0·02
Krupitsky et al., CPDD, 2017
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Viral Load among patients stabilized on oral or
implantable naltrexone
IMP
LA
NT
More RNA suppression in NI than ON [66% vs 50%; OR (95%CI)=1.94 (1.10-3.43)]
Krupitsky et al., CPDD, 2017
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Conclusion
Evidence based studies conducted in Russia
demonstrated that long-acting naltrexone is more
effective in the treatment of opioid use disorder
compared to oral naltrexone and placebo
An implant that is approved in the Russian Federation
and provides opioid blockade for three months improves
ART retention and HIV treatment outcomes
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Disclosure
■ Studies of oral naltrexone, and
naltrexone implant were
approved by Russian Ministry of
Health and supported by the
grant from the National Institute
on Drug Abuse, USA
■ Study of a injectable formulation
of naltrexone was supported by
Alkermes, Inc., USA