Evidence map›Paper›PMID 38776423›Full record

Trial reportJournal of addiction medicine

Machine Learning-Driven Analysis of Individualized Treatment Effects Comparing Buprenorphine and Naltrexone in Opioid Use Disorder Relapse Prevention.

Majid Afshar, Emma J Graham Linck, Alexandra B Spicer, John Rotrosen, Elizabeth M Salisbury-Afshar, Pratik Sinha, Matthew W Semler, Matthew M Churpek

Abstract readRandomized Controlled TrialMulticenter StudyComparative Study
In one paragraph

Trial report in Journal of addiction medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Majid AfsharFrom the University of Wisconsin School of Medicine and Public Health, Madison, WI (MA, EJGL, ABS, EMS-A, MMC); New York University Grossman School of Medicine, New York, NY (JR); Washington University School of Medicine, Saint Louis, MO (PS); and Vanderbilt University Medical Center, Nashville, TN (MWS).
Emma J Graham Linck
Alexandra B Spicer
John Rotrosen
Elizabeth M Salisbury-Afshar
Pratik Sinha
Matthew W Semler
Matthew M Churpek

Funding

Project-003UG1DA013035 · NIDA · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · PI Aimee N Campbell, Jennifer McNeely · 2015 to 2026
$130.3M
CU PARTNERS: NY/LONG ISLAND REGIONAL NODEU10DA013035 · NIDA · NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC · PI NUNES, EDWARD V., ROTROSEN, JOHN P · 2001 to 2015
$47.6M
Research Training for Computation and Informatics in Biology and MedicineT15LM007359 · NLM · UNIVERSITY OF WISCONSIN-MADISON · PI Mark W. Craven, Colin Noel Dewey · 2002 to 2026
$22.6M
Data Driven Strategies for Substance Misuse Identification in Hospitalized PatientsR01DA051464 · NIDA · UNIVERSITY OF WISCONSIN-MADISON · PI Majid Afshar · 2020 to 2026
$4.5M
Precision Medicine in Sepsis with Critical IllnessR35GM142992 · NIGMS · WASHINGTON UNIVERSITY · PI Pratik Sinha · 2021 to 2026
$2.4M
Sepsis Early Prediction and Subphenotype Illumination Study (SEPSIS)R35GM145330 · NIGMS · UNIVERSITY OF WISCONSIN-MADISON · PI Matthew Michael Churpek · 2022 to 2026
$1.9M
NIDA NIH HHS R01 DA051464NIDA NIH HHS U10 DA013035NIDA NIH HHS UG1 DA013035NIGMS NIH HHS R35 GM142992NIGMS NIH HHS R35 GM145330NLM NIH HHS T15 LM007359
6 · The paper itself

Abstract

objectiveA trial comparing extended-release naltrexone and sublingual buprenorphine-naloxone demonstrated higher relapse rates in individuals randomized to extended-release naltrexone. The effectiveness of treatment might vary based on patient characteristics. We hypothesized that causal machine learning would identify individualized treatment effects for each medication.

methodsThis is a secondary analysis of a multicenter randomized trial that compared the effectiveness of extended-release naltrexone versus buprenorphine-naloxone for preventing relapse of opioid misuse. Three machine learning models were derived using all trial participants with 50% randomly selected for training (n = 285) and the remaining 50% for validation. Individualized treatment effect was measured by the Qini value and c-for-benefit, with the absence of relapse denoting treatment success. Patients were grouped into quartiles by predicted individualized treatment effect to examine differences in characteristics and the observed treatment effects.

resultsThe best-performing model had a Qini value of 4.45 (95% confidence interval, 1.02-7.83) and a c-for-benefit of 0.63 (95% confidence interval, 0.53-0.68). The quartile most likely to benefit from buprenorphine-naloxone had a 35% absolute benefit from this treatment, and at study entry, they had a high median opioid withdrawal score ( P < 0.001), used cocaine on more days over the prior 30 days than other quartiles ( P < 0.001), and had highest proportions with alcohol and cocaine use disorder ( P ≤ 0.02). Quartile 4 individuals were predicted to be most likely to benefit from extended-release naltrexone, with the greatest proportion having heroin drug preference ( P = 0.02) and all experiencing homelessness ( P < 0.001).

conclusionsCausal machine learning identified differing individualized treatment effects between medications based on characteristics associated with preventing relapse.

Indexed as

Buprenorphine, Naloxone Drug CombinationMachine LearningNaltrexoneNarcotic AntagonistsOpioid-Related DisordersSecondary PreventionAdultBuprenorphineDelayed-Action PreparationsFemaleHumansMaleMiddle AgedOpiate Substitution TreatmentPrecision MedicineBuprenorphineBuprenorphine, Naloxone Drug CombinationDelayed-Action PreparationsNaltrexoneNarcotic Antagonists

Identifiers

PMID38776423
PMCPMC11446670

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.