Buprenorphine or Morphine for Treatment of Neonatal Abstinence Syndrome?

Buprenorphine could potentially have better treatment outcomes in infants with neonatal abstinence syndrome (NAS) than traditionally used oral morphine, according to a study recently published in the New England Journal of Medicine.

The phase 3 randomized clinical trial, known as B-BORN, compared sublingual buprenorphine treatment to oral morphine and was a follow-up of earlier phase studies that indicated buprenorphine could reduce length of opioid withdrawal treatment and hospitalization. Researchers evaluated 63 infants with NAS, 97% of whom were exposed to methadone.

The researchers found that buprenorphine decreased the length in treatment by 42% compared to morphine. The length of treatment for buprenorphine (15 days) was significantly shorter than with morphine (28 days), and the average duration of hospital stay for buprenorphine was 21 days versus 33 days for morphine.

Supplemental phenobarbital treatment was also evaluated. The researchers concluded that 15% of infants in the buprenorphine group and 23% of infants in the morphine group needed adjunctive treatment with phenobarbital.

Additionally, no safety issues with buprenorphine were noted. Similar rates of adverse events were reported in both groups.

The researchers concluded that buprenorphine can serve as a safe and effective treatment for NAS that may help reduce the burden associated with lengthy treatment and hospitalization.

The study was funded by the National Institute on Drug Abuse.

Reference

Kraft WK, Adeniyi-Jones SC, Chervoneva I, et al. Buprenorphine for the treatment of the neonatal abstinence syndrome. NEJM. May 4, 2017; doi: 10.1056/NEJMoa1614835