This study conducted in US is one of two concurrent trials comparing sublingual buprenorphine-naloxone (BUP-NX) with extended-release naltrexone (XR-NTX); the other was a Norwegian study which showed similar retention and effectiveness of both agents.
A commentary notes that the US study addresses several outstanding questions about use of XR-NTX in real-world settings regarding feasibility of induction, and the safety and effectiveness of the treatment. It adds that the common situation of choosing between XR-NTX and BUP-NX is highly complex, involving numerous factors such as patient preference, treatment history, current level of physiological opioid dependence, and access to detoxification treatment, among others. It advises that with patients who are in an opioid-dependent state, the higher chance of induction failure and subsequent relapse with XR-NTX induction attempts must be carefully considered, unless they will be in a controlled setting long enough to withdraw completely from opioids before induction. It suggests BUP-NX might be a safer initial strategy for many of these patients because of the better chance of a quick successful induction; and for patients fully withdrawn from opioids, XR-NTX can now be considered a good treatment option with equivalent safety and effectiveness to BUP-NX.
Another commentary notes that ongoing research on the genetic and clinical features that influence treatment response will ultimately support personalised treatment selection. But for now, choice of medications should consider the patient's needs, comorbidities, and access to care.