Extended-release Buprenorphine Compared to Sublingual Buprenorphine in Rural Settings (RXR)

NCT ID: NCT06023459

Last Updated: 2025-12-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

PHASE3

Total Enrollment

144 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-10-14

Study Completion Date

2026-02-28

Brief Summary

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This pilot trial will explore the feasibility, acceptability, and effectiveness of the most recently approved formulation of injectable extended-release buprenorphine (XR-BUP) for treatment of opioid use disorder (OUD) in rural settings. We will randomize 144 eligible individuals with moderate to severe OUD in a 2:1 ratio to one of two medication conditions: (1) XR-BUP (128mg target), administered every 4 weeks or (2) SL-BUP (16mg-24 mg/day target).Participants will receive study medication treatment for the 14 week-intervention period, including an initial \~2-week period of induction/stabilization. The study will use a mixed-methods approach (participant assessments, study medication records, qualitative interviews) for assessing feasibility and acceptability, and results will include patient outcome data on the comparative effectiveness of XR-BUP versus SL-BUP for patients with OUD in rural settings.

Detailed Description

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This 24-month randomized controlled open-label pilot study will be conducted in approximately 6 clinics in rural settings. The study objectives are to describe the feasibility of implementing the study in rural settings, document the acceptability of the XR-BUP condition, and assess the comparative effectiveness of XR-BUP compared with SL-BUP. Participants will be randomized within each clinic to XR-BUP or SL-BUP in a ratio of 2:1 (overall approximately 96 in the XR-BUP condition, 48 in the SL-BUP condition). They will receive study medication for approximately 14 weeks following randomization, including an initial \~2-week period of induction/stabilization. The XR-BUP condition will use Brixadi®/CAM2038 injectable, extended-release buprenorphine. The measure for the main comparative effectiveness outcome is number of urine drug screen (UDS) results negative for opioids at scheduled assessments during Week 2 through Week 14 of the trial. Missing or positive UDS for any non-prescribed opioid is considered UDS positive.

Conditions

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Opioid-Related Disorders Substance-Related Disorders Narcotic-Related Disorders

Keywords

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Opioid Use Disorder Opioid Medication Assisted Treatment Buprenorphine Comparative Effectiveness Research

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

A 24-month randomized controlled open-label pilot study will be conducted in approximately 6 clinics in rural settings. Participants will be randomized within each clinic to XR-BUP or SL-BUP in a ratio of 2:1 (overall approximately 96 in the XR-BUP condition, 48 in the SL-BUP condition). They will receive study medication for approximately 14 weeks following randomization, including an initial \~2-week period of induction/stabilization.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Injectable extended-release buprenorphine (XR-BUP)

Participants will be randomly assigned to XR-BUP, with approximately 96 in the XR-BUP condition. The XR-BUP condition will use Brixadi/CAM2038 injectable, extended-release buprenorphine (Braeburn Pharmaceuticals, Inc.). After titrating to a stable dosage in approximately two weeks using weekly injection dosages as clinically indicated to relieve cravings and withdrawal symptoms, the target monthly dosage (128mg) of XR-BUP will be administered by injection at approximately Day 14 and approximately four weeks later in Week 6, with a third injection in Week 10. Dosage adjustments will be made as indicated for tolerability.

Group Type EXPERIMENTAL

Injectable extended-release buprenorphine

Intervention Type DRUG

Participants randomized to the XR-BUP condition will receive XR-BUP study medication for approximately 14 weeks following randomization, including an initial \~2-week period of induction/stabilization.

Sublingual buprenorphine-naloxone (SL-BUP)

Participants will be randomly assigned to SL-BUP with approximately 48 in the SL-BUP condition. The SL-BUP condition will use sublingual buprenorphine-naloxone, with a target maintenance daily dose range of 16-24mg as recommended for clinical practice. Titration to maintenance dosage will be attempted within the first two weeks of the SL-BUP condition. During the initial stabilization weeks, SL-BUP will be flexibly dosed as clinically indicated to relieve cravings and withdrawal symptoms, after which dosage adjustments will be based on clinical decisions by the site clinicians. The maintenance dosage of SL-BUP will be dispensed on a schedule similar to the XR-BUP injections (i.e., at approximately Day 14, Week 6, and Week 10).

Group Type ACTIVE_COMPARATOR

Sublingual buprenorphine-naloxone

Intervention Type DRUG

Participants randomized to the SL-BUP condition will receive SL-BUP study medication for approximately 14 weeks following randomization, including an initial \~2-week period of induction/stabilization.

Interventions

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Injectable extended-release buprenorphine

Participants randomized to the XR-BUP condition will receive XR-BUP study medication for approximately 14 weeks following randomization, including an initial \~2-week period of induction/stabilization.

Intervention Type DRUG

Sublingual buprenorphine-naloxone

Participants randomized to the SL-BUP condition will receive SL-BUP study medication for approximately 14 weeks following randomization, including an initial \~2-week period of induction/stabilization.

Intervention Type DRUG

Other Intervention Names

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XR-BUP (Brixadi) SL-BUP

Eligibility Criteria

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Inclusion Criteria

1. Be ≥18 years of age
2. Meet DSM-5 criteria for moderate to severe OUD or be on buprenorphine medication for OUD
3. Be interested in receiving buprenorphine treatment for OUD
4. Be willing to be randomized to either SL-BUP or XR-BUP
5. Be willing to comply with all study procedures
6. Be in good general health, as determined by the study Medical Clinician based on medical/psychiatric histories and physical exam, to permit treatment in an outpatient setting
7. If female of childbearing potential, be willing to practice an effective method of birth control for the duration of participation in the study intervention and agree to study-administered pregnancy testing during their participation in the study
8. Be able to speak English sufficiently to understand the study procedures
9. Be willing and able to provide written informed consent to participate in the study

Exclusion Criteria

1. Have evidence of a serious psychiatric disorder as assessed by the study Medical Clinician that would make participation difficult or unsafe (e.g., active psychosis, severe depression, or mania)
2. Have suicidal or homicidal ideation or behavior that requires immediate attention
3. Have a medical condition or serious medical illness that, in the opinion of the study Medical Clinician, would make study participation medically unsafe
4. Have been in treatment with naltrexone within 28 days of consent
5. Have been in methadone maintenance treatment within 28 days of consent
6. Be taking medication or require any medication that, in the judgment of the study Medical Clinician, could interact adversely with study medication
7. Have known allergy or sensitivity to SL-BUP or XR-BUP formulations or their components
8. Be currently incarcerated or have pending legal action that could preclude participation in study activities
9. Have other situation that might prevent the participant from remaining in the area for the duration of the study (e.g., planned move)
10. Have a current pattern of alcohol, benzodiazepine, or other sedative hypnotic use, as determined by the study Medical Clinician, that would require a different level of care and preclude safe participation in the study
11. Be currently pregnant or breastfeeding or planning on conception
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute on Drug Abuse (NIDA)

NIH

Sponsor Role collaborator

National Institutes of Health (NIH)

NIH

Sponsor Role collaborator

The Emmes Company, LLC

INDUSTRY

Sponsor Role collaborator

University of California, Los Angeles

OTHER

Sponsor Role collaborator

RAND

OTHER

Sponsor Role collaborator

Cornell University

OTHER

Sponsor Role collaborator

Oregon Health and Science University

OTHER

Sponsor Role collaborator

University of Illinois at Chicago

OTHER

Sponsor Role collaborator

University of Washington

OTHER

Sponsor Role collaborator

West Virginia University

OTHER

Sponsor Role collaborator

Yih-Ing Hser

OTHER

Sponsor Role lead

Responsible Party

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Yih-Ing Hser

Distinguished Research Professor, Department of Psychiatry and Behavioral Sciences, Geffen School of Medicine

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Yih-Ing Hser, PhD

Role: PRINCIPAL_INVESTIGATOR

University of California, Los Angeles

Larissa Mooney, MD

Role: PRINCIPAL_INVESTIGATOR

University of California, Los Angeles

Locations

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AppleGate Recovery El Dorado

El Dorado, Arkansas, United States

Site Status

Southern Humboldt Community Healthcare District - Jerold Phelps Community Hospital

Garberville, California, United States

Site Status

Gibson Area Hospital and Health Services - Gibson Recovery Optimizing Wellness

Gibson City, Illinois, United States

Site Status

Penobscot Community Health Care Inc. - Seaport Community Health Center

Belfast, Maine, United States

Site Status

Oregon Health & Science University Primary Care Clinic, Scappoose

Scappoose, Oregon, United States

Site Status

Providence Northeast Washington Medical Group

Colville, Washington, United States

Site Status

New Beginnings Recovery Clinic & Behavioral Health Center

New Martinsville, West Virginia, United States

Site Status

Countries

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United States

Other Identifiers

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UG1DA049435

Identifier Type: NIH

Identifier Source: secondary_id

View Link

CTN-0102-XR

Identifier Type: -

Identifier Source: org_study_id