Summary of findings 1. Methadone compared to buprenorphine for opiate‐dependent pregnant women.
| Methadone compared to buprenorphine for opiate‐dependent pregnant women | ||||||
| Patient or population: opiate‐dependent pregnant women Setting: outpatients Intervention: methadone Comparison: buprenorphine | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with buprenorphine | Risk with methadone | |||||
| Dropout rate follow‐up: range 15 weeks to 18 weeks | Study population | RR 0.66 (0.37 to 1.20) | 223 (3 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 318 per 1000 | 210 per 1000 (118 to 382) | |||||
| Use of primary substance follow‐up: range 15 weeks to 18 weeks | Study population | RR 1.81 (0.70 to 4.68) | 151 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | ||
| 75 per 1000 | 135 per 1000 (52 to 349) | |||||
| Birth weight follow‐up: mean 18 weeks | The mean birth weight ranged from 3.093 g to 3530 gr | MD ranged from ‐530.00 gr (662.78,lower to 397.22 lower) to ‐215.00 gr (238.93, lower to 191.07 lower) | ‐ | 19 and 131 participants (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 2 3 4 | |
| APGAR score Scale from: 0 to 10 follow‐up: mean 18 weeks | The mean APGAR score was 8.95 | MD 0 (0.03 lower to 0.03 higher) | ‐ | 163 (2 RCTs) | ⊕⊕⊝⊝ LOW 2 4 | |
| Number treated for NAS follow‐up: range 15 weeks to 18 weeks | Study population | RR 1.19 (0.87 to 1.63) | 166 (3 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | ||
| 447 per 1000 | 532 per 1000 (389 to 729) | |||||
| Serious adverse events for the mother | Study population | RR 1.69 (0.75 to 3.83) | 175 (1 RCT) | ⊕⊕⊝⊝ LOW 1 2 | ||
| 93 per 1000 | 157 per 1000 (70 to 356) | |||||
| Serious adverse events for the child | Study population | RR 4.77 (0.59 to 38.49) | 131 (1 RCT) | ⊕⊕⊝⊝ LOW 1 2 | ||
| 17 per 1000 | 82 per 1000 (10 to 664) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio; | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 downgraded one level due to imprecision: optimal information size not met
2 downgraded one level due to study limitations: high risk of attrition bias
3 downgraded one level due to inconsistency: high heterogeneity: I2 95%
4 downgraded one level due to imprecision: fewer than 400 participants