COMMIT
Trial question
What is the effect of initiation of long-acting buprenorphine in patients hospitalized with an infection related to opioid use disorder?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
49.0% female
51.0% male
N = 171
171 patients (83 female, 88 male).
Inclusion criteria: patients hospitalized with an infection related to opioid use disorder.
Key exclusion criteria: severe medical or psychiatric disability making participation unsafe; pregnancy, planning conception, or breastfeeding; contraindications to buprenorphine; moderate-to-severe liver impairment; durable maintenance with medications for opioid use disorder for 30 days prior to hospitalization and intending to continue medications for opioid use disorder after discharge; no informed consent.
Interventions
N=86 buprenorphine (injectable long-acting buprenorphine combined with infectious disease management).
N=85 usual care (usual management of opioid use disorder).
Primary outcome
Proportion of patients who received any form of medications for opioid use disorder at 12 weeks
59.3%
54.1%
59.3 %
44.5 %
29.6 %
14.8 %
0.0 %
Buprenorphine
Usual
care
No significant
difference ↔
No significant difference in the proportion of patients who received any form of medications for opioid use disorder at 12 weeks (59.3% vs. 54.1%; RR 1.01, 95% CI 0.78 to 1.3).
Secondary outcomes
No significant difference in cured for index infection at 12 weeks (79.3% vs. 81%; RR 0.96, 96% CI 0.84 to 1.11).
No significant difference in pain score on Pain, Enjoyment, and General Activity Scale at 12 weeks (2.8 points vs. 3.7 points; MD -0.78, 95% CI -1.83 to 0.16).
No significant difference in PHQ-9 score at 12 weeks (7.59 points vs. 8.76 points; MD -0.86, 95% CI -2.88 to 1.15).
Safety outcomes
No significant differences in adverse events, nonfatal serious adverse events.
Conclusion
In patients hospitalized with an infection related to opioid use disorder, buprenorphine was not superior to usual care with respect to proportion of patients who received any form of medications for opioid use disorder at 12 weeks.
Reference
Nikhil Seval, Prerana Roth, Cynthia A Frank et al. Initiating Injectable Buprenorphine in People Hospitalized With Infections: A Randomized Clinical Trial. JAMA Netw Open. 2025 May 1;8(5):e2513000.
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