Comparison of Brixadi vs Sublocade Treatment Outcomes for Opioid Use Disorder
Both Brixadi (buprenorphine) and Sublocade (buprenorphine) are effective long-acting injectable formulations for opioid use disorder treatment, with Sublocade having more established clinical evidence showing 61.5-75.8% abstinence rates after 12 months of treatment and retention rates of approximately 50%. 1
Overview of Long-Acting Injectable Buprenorphine Options
- Long-acting injectable buprenorphine formulations represent an advancement in medication-assisted treatment for opioid use disorder (OUD), offering alternatives to daily oral or sublingual administration 2
- Both Brixadi (CAM 2038) and Sublocade (RBP-6000) are subcutaneous buprenorphine depot formulations specifically developed for OUD treatment 2
- These formulations are recommended for patients who have been stabilized on transmucosal buprenorphine and can help address adherence challenges associated with daily dosing 3
Clinical Efficacy of Sublocade
- Sublocade demonstrated strong clinical outcomes in a 12-month study with 61.5% of continuing participants and 75.8% of new participants achieving abstinence after a full year of treatment 1
- Retention rates for Sublocade treatment were approximately 50.6% for participants continuing from previous studies and 50.5% for new participants after 12 months 1
- The standard protocol for Sublocade involves initial doses of 300 mg monthly for the first two months, followed by maintenance doses of 100 mg monthly 3
- Sublocade has been shown to reduce opioid cravings and block the euphoric effects of opioids, similar to other buprenorphine formulations 4
Clinical Considerations for Both Formulations
- Patients must be stabilized on 8-24 mg daily of sublingual or buccal buprenorphine for at least 7 consecutive days before transitioning to any injectable formulation to avoid precipitated withdrawal 3
- Both formulations require patients to demonstrate tolerance to buprenorphine before initiation 3
- Monitoring for injection site reactions is important, though these are typically mild to moderate in severity 1
- The incidence of treatment-emergent adverse events with Sublocade decreases over time, with fewer events reported in the second 6 months of treatment compared to the first 6 months 1
Dosing Considerations
- Higher buprenorphine dosing (up to 32 mg/day in oral formulations) has been associated with improved outcomes, including decreased opioid use and better retention rates 5
- This suggests that adequate dosing of long-acting formulations is similarly important for optimal treatment outcomes 5
- For Sublocade, the recommended maintenance dose is 100 mg monthly, though some patients may benefit from continuing the 300 mg monthly dose 3
Integration with Comprehensive Treatment
- All medication-assisted treatments for OUD, including long-acting buprenorphine formulations, are most effective when combined with behavioral therapies 6
- Evidence-based treatment for OUD typically includes medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies 6
- Integrated treatment approaches that address substance use disorders alongside HIV prevention and treatment (when applicable) show improved outcomes 6
Provider Requirements and System Considerations
- Providers must have appropriate training and certification to prescribe buprenorphine products for OUD 6
- Barriers to buprenorphine treatment include lack of institutional support, insufficient mental health and psychosocial support resources, time constraints, and lack of specialty backup 6
- Expanding access to medication-assisted treatment is a priority, as many patients with OUD do not receive appropriate medical treatment 4
While both Brixadi and Sublocade offer advantages over daily buprenorphine administration, Sublocade currently has more robust long-term efficacy data demonstrating sustained abstinence and reasonable retention rates in OUD treatment.