RCT Comparing Methadone and Buprenorphine in Pregnant Women
Children born to women who abuse drugs have a high risk of being born with birth defects and developmental problems. Methadone is a drug that is commonly used for treating opioid dependence. However, its use by a pregnant woman can cause severe withdrawal symptoms in a newborn because of the prenatal exposure. The purpose of this study is to evaluate the effectiveness of buprenorphine, another drug, versus methadone in reducing withdrawal symptoms in children born to opioid-dependent women.
Opioid Related Disorders
|Study Design:||Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||Maternal Opioid Treatment: Human Experimental Research|
- Child's Head Circumference Measurement (Measured at Birth) [ Time Frame: birth ] [ Designated as safety issue: Yes ]
- Child's Length of Hospital Stay [ Time Frame: delivery until hospital discharge (min=2 days, max=79 days) ] [ Designated as safety issue: Yes ]
- Number of Children Requiring Treatment for Neonatal Abstinence Signs (NAS) [ Time Frame: From birth until hospital discharge (min=4 days, max=10, depending on site) ] [ Designated as safety issue: Yes ]Neonatal abstinence syndrome (NAS) characterized by hyperirritability of the central nervous system and dysfunction in the autonomic nervous system, gastrointestinal tract, and respiratory system.11 When left untreated, NAS can result in serious illness (e.g., diarrhea, feeding difficulties, weight loss, and seizures) and death.
- Child's Peak Daily Total NAS Score [ Time Frame: minimum twice daily from birth until NAS no longer measured (min=10 days) ] [ Designated as safety issue: Yes ]NAS was measured with the MOTHER NAS scale, which includes 28 items, 19 of which are used for scoring and medication decisions. Scores can range from 0 to 42, with higher scores indicating more severe withdrawal.
- Total Amount of Morphine Sulfate That a Neonate Receives to Treat NAS [ Time Frame: Start of NAS treatment until discontinuation of NAS treatment (min=0 days, max=76 days) ] [ Designated as safety issue: Yes ]Total amount in mg
- Mother's Self-report of Drug Use (Measured Monthly by Time Line Follow Back) [ Time Frame: monthly from study entry until discontinuation or delivery (min=29 days, max=239 days) ] [ Designated as safety issue: No ]
- Mother's HIV Risk Behaviors (Measured Monthly by Risk Behavior Assessment) [ Time Frame: monthly from study entry until discontinuation or delivery (min=29 days, max=239 days) ] [ Designated as safety issue: Yes ]
- Mother's Measures of Dose Adequacy and Acceptance Over Time (Measured Weekly by Dose Adequacy Measure) [ Time Frame: from study entry until discontinuation or delivery (min=29 days, max=239 days) ] [ Designated as safety issue: No ]Pregnant women maintained on an opioid agonist medication may require upward adjustment to their medication during the course of pregnant. The Dose Adequacy Measure represented a recordation of dosing adjustments during the course of the study.
- Mother's Psychosocial Functioning at Delivery as Measured by the Addiction Severity Index Psychosocial Index Score [ Time Frame: at delivery ] [ Designated as safety issue: No ]The Addiction Severity Index is a structured clinical interview that assesses problem severity in 7 areas of functioning: alcohol use, drug use, medical, legal, employment, psychosocial, and psychiatric status. Each area of functioning yields a composite scale score between 0 and 1, with higher scores indicating greater problem severity in that area. Only the psychosocial index was examined in this study.
|Study Start Date:||July 2005|
|Study Completion Date:||June 2010|
|Primary Completion Date:||August 2009 (Final data collection date for primary outcome measure)|
sl daily 2-32 mg
Active Comparator: Methadone
daily oral dosing 20-140 mg
Women who use drugs during pregnancy place their unborn children at high risk for being born addicted to drugs. Such children may also be born with birth defects and may experience learning and behavioral problems. Methadone, a synthetic narcotic, is commonly prescribed to treat opioid addiction. It may not be an optimal solution for opioid-dependent pregnant women, however, because a large percentage of children born to women taking methadone experience severe drug withdrawal symptoms at birth that often require medical treatment. Common opioid withdrawal symptoms, described as neonatal abstinence syndrome (NAS) in babies, include tremors, irritability, sleep problems, seizures, dehydration, and fever. Buprenorphine is a medication that has been approved to treat opioid dependence in individuals who are not pregnant but has not been approved for pregnant individuals. Past research has shown that use of buprenorphine in pregnant women results in improved birth outcomes over methadone. The purpose of this study is to evaluate the effectiveness of buprenorphine versus methadone at reducing opioid withdrawal symptoms in babies born to opioid-dependent women.
This study will enroll opioid-dependent pregnant women who are 13 to 30 weeks pregnant and will follow each woman and her child throughout the pregnancy until 6 weeks postpartum. All participants will undergo an initial screening that will last several hours. Participants will then be randomly assigned to receive either methadone or buprenorphine on a daily basis, and will be required to visit the clinic each day to receive their medication. Outcome measurements will be assessed at weekly study visits throughout the pregnancy, and will include drug use, HIV risk behaviors, medication dose adequacy and safety, treatment retention, and psychosocial functioning. Urine samples will be collected 3 times a week, and blood will be drawn throughout the pregnancy for safety monitoring. Outcome measurements related to the baby will include head circumference measurement, length of hospital stay, severity and frequency of withdrawal symptoms, and amount of medication needed to control withdrawal symptoms.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00271219
|United States, Maryland|
|Johns Hopkins University School of Medicine|
|Baltimore, Maryland, United States, 21224|
|United States, Michigan|
|Wayne State University|
|Detroit, Michigan, United States, 48207|
|United States, Pennsylvania|
|Thomas Jefferson University|
|Philadelphia, Pennsylvania, United States, 19107|
|United States, Rhode Island|
|Providence, Rhode Island, United States, 02912|
|United States, Tennessee|
|Nashville, Tennessee, United States, 37232|
|United States, Vermont|
|University of Vermont|
|Burlington, Vermont, United States, 05401|
|Medical University of Vienna|
|Vienna, Austria, A1090|
|St. Joseph's Health Centre|
|Toronto, Ontario, Canada, M6R 1B5|
|Principal Investigator:||Hendree E. Jones, PhD||Johns Hopkins University|