Relationship between extended-release buprenorphine adherence and reduced risk of return to use in patients with opioid use disorder: A retrospective claims data analysis

To evaluate the association between adherence to monthly extended-release buprenorphine (BUP-XR) and reducing relapse among patients with opioid use disorder (OUD). This retrospective claims analysis included adult patients (age≥18 years) initiating monthly BUP-XR between 3/1/2019-12/31/2022 (index date=earliest BUP-XR claim date) in the Merative™ MarketScan® Commercial/Medicare/Medicaid Databases. Patients had continuous enrollment with medical/pharmacy/behavioral health benefits for 12 months pre-index (baseline period) and 12 months post-index (follow-up period). Patients were categorized to four mutually-exclusive groups: Group 1 (adherent [proportion of days covered; PDC≥0.8] to BUP-XR treatment); Group 2 (adherent to overall MOUD but BUP-XR PDC<0.8); Group 3 (non-adherent to overall MOUD and primarily treated with BUP-XR); Group 4 (non-adherent to overall MOUD and not primarily treated with BUP-XR). Descriptive and adjusted analyses compared the relapse prevalence during follow-up for Group 1 (reference) to other groups. Of 3,400 patients, 19.8% were adherent to BUP-XR (Group 1) during the 12-month follow-up (20.9% in Group 2, 39.9% in Group 3, and 19.4% in Group 4). Compared to BUP-XR adherent patients (Group 1), patients non-adherent to BUP-XR were significantly more likely to have a relapse (adjusted odds ratios of 3.49 for Group 2, 3.30 for Group 3, and 8.08 for Group 4; all p<0.001), including Group 2 patients who had BUP-XR PDC<0.8 but were adherent to overall MOUD. Adherence to monthly BUP-XR 100 mg or 300 mg in the 12 months following treatment initiation was associated with reduced odds of relapse compared to less consistent use of BUP-XR and continued adherence to other MOUD. • Adherence to extended-release buprenorphine (BUP-XR) greatly reduced relapse risk. • BUP-XR was 3.5 times more effective than other medications at preventing relapses. • Only 4.5% of patients adherent to BUP-XR had evidence of a relapse (return to use).