In this first episode of the Yeah No Journal Club, we take a joyful romp through the X:BOT study to tackle two important questions. (1) Is extended-release naltrexone or daily buprenorphine-naloxone more effective for treating adults with opioid use disorder? (2) Why does it matter if a study uses a per-protocol or intent-to-treat analysis**? It turns out that getting an answer to the first question requires understanding the second one. **And don't worry if you don't know what a per protocol or intent to treat analysis is--you will after listening to this. (Adriane dela Cruz, M.D., Ph.D., is an Assistant Professor of Psychiatry at UT Southwestern Medical Center and with the Peter O’Donnell Jr. Brain Institute who focuses on treating patients with drug and alcohol addictions. The opinions expressed are her own and do not reflect those of UT Southwestern, the O’Donnell Brain Institute, the UT System, or the state.)
We discuss the X:BOT primary outcomes paper in this episode of the podcast. Use the link above or the citation below to find it. Take a look at the figures!
JD Lee et al. Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicenter, open-label, randomized controlled trial. Lancet 2018. 391:309-318.
X:BOT rationale and design paper
In this fascinating and thoughtful paper, the X:BOT authors discuss the study design choices they considered and how they selected various aspects of the trial design. A great read for those with interest in OUD treatment or clinical trials design.
X:BOT cost effectiveness analysis
This planned analysis of the X:BOT data provides an additional lens for determining which medication is the best option.
Thorough but brief review on the use of buprenorphine.