妊娠中と産後におけるブプレノルフィンとメタドンの使用停止: 全国的なコホート研究
Chih-Wan Grace Lin1, Brian T Bateman2, Loreen Straub1
1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston.
The American journal of psychiatry
|August 27, 2025
まとめ
ブプレノルフィン治療を開始したオピオイド使用障害の妊婦は,メタドンと比較して治療を中止する可能性が高くなった. 両方の治療において高い中止率が観察され,保持障壁に対処する必要性を強調した.
科学分野:
- 産婦人科
- 依存症 医学
- 薬理学について
背景:
- 妊娠中のオピオイド使用障害 (OUD) の治療は,母親と新生児のアウトカムにとって不可欠です.
- メタドンとブプレノルフィンは妊娠中のOUDの重要な薬です.
- 妊娠中および産後におけるOUD治療の中止率に関する証拠は限られている.
研究 の 目的:
- 妊娠中のブプレノルフィンとメタドンの治療中止率を比較する.
- 産後1年間の治療中断を評価する.
- ブプレノルフィン製剤 (単独またはナロクソンと併用) による治療中止を分析する.
主な方法:
- 全国のメディケイドデータを活用した 遡及的なコホート研究
- メタドンまたはトランスムコサルブプレノルフィンを最初の3ヶ月間にOUDで開始した妊婦を含む.
- 治療中断は≥60日間のギャップとして定義され,Cox比危険性回帰を用いて分析され,傾向スコアが重複する.
主要な成果:
- ブプレノルフィンを投与開始した女性は,メタドン (25. 6%) と比べて妊娠中に治療中止率が高かった.
- メタドン (49. 0%) と比較して,ブプレノルフィン (58. 8%) の1年後の中止率は高かった.
- ブプレノルフィン/ ナロクソン併用は,ブプレノルフィン単独投与 (1. 14 妊娠期間, 1. 23 産後) よりも,更期リスク比率が高かった.
結論:
- 妊娠初期にブプレノルフィンを投与した妊婦は,メタドンと比較して治療中止の可能性が高くなった.
- ブプレノルフィンとメタドンの両方の治療中断率は高かった.
- 妊娠中のOUD患者にとって,治療の継続に対する障壁を特定し,対処することが重要です.
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