Monoclonal antibodies: a new weapon against opiates?

Monoclonal antibodies: a new weapon against opiates?

Plus: Promising Results for Digital SUD Therapy and a Novel ER Intervention for Heavy Drinkers

By Mark Mravic

In recent decades, monoclonal antibodies (mAb) have become a valuable part of the treatment toolkit for a variety of conditions, from certain cancers to inflammatory and autoimmune disorders, multiple sclerosis, and even migraines. During the pandemic, monoclonal antibodies emerged as a COVID-19 therapy for people with immunodeficiencies, and mAbs are under intense investigation as possible Alzheimer’s treatment. Now scientists at Scripps Research believe they have found a monoclonal antibody that could neutralize heroin, mitigating both its psychoactive effects and its lethality. And another opioids such as fentanyl are also being targeted.

Also, this week, we look at therapeutic pearreSET digital therapy, showing promising real-world effectiveness for people recovering from SUD, and a simple emergency intervention that could reduce long-term heavy drinking.

Of ACS Core Sciences:
A monoclonal antibody against heroin

kim janda

Scientists at Scripps Research in San Diego have discovered a monoclonal antibody that is surprisingly effective at blocking heroin’s pain-killing effect, as well as its dangerous slowing of heart and breathing rates, the leading cause of overdose death. In a study involving mice, Professor Scripps Dr Kim Janda, and his team discovered a particular antibody, 11D12, that binds to the heroin molecule and neutralizes its physiological and mood-altering effects. While previous research has focused on the heroin metabolites 6-acetylmorphine and morphine, which the body rapidly converts from heroin, as targets for therapy, this study suggests that heroin itself is the best target. “The focus on metabolites has basically confused the field,” Janda said. in a throw. “Our report will reset research in a direction where successful clinical trials should now be achieved.”

Adding to the promise, the Scripps team found that a single dose of the antibody remained active in the system for weeks, in contrast to existing pharmaceutical treatments for opioids that wear off within hours. Antibody persistence could be an advantage in addiction treatment; For example, one could envision a potential therapy involving monoclonal antibody infusions every two weeks, rather than daily doses of buprenorphine either methadone which are the current standard of care.

The next step for the Scripps team will be to create and test a human version of the heroin antibody. Interestingly, Janda and her colleagues have been simultaneously developing a human monoclonal antibody that neutralizes fentanyl, carfentanil, and other synthetic opioids.

“This is the first report of a mAb that can significantly protect against lethal doses of heroin and suggests a necessary paradigm shift for the future development of effective immunopharmacotherapy against heroin,” the study reads.

Of The American Magazine on Addictions:
Encouraging data for Pear’s reSET therapy

The COVID-19 pandemic has shed light on the need to expand treatment options for substance use disorder (SUD) beyond traditional clinical and counseling settings. One such option is Pear Therapeutics’ reSET, an FDA-approved prescription digital therapy (PDT) that provides cognitive behavioral therapy, relapse prevention strategies, contingency management and other resources to people in recovery. The technology also automatically records participation, retention and substance use data, in the form of self-report and urine drug results, which can be accessed by clinicians supervising treatment through a digital dashboard.

So how effective is such an intervention? a recent real world study examined 602 patients, across 28 states and from a broad demographic range, who filled a 12-week prescription for reSET and participated in the therapy at least once. Substances for which patients were being treated included alcohol (47%), opioids (18%), stimulants (13%), cannabis (8%), and cocaine (7%).

Of the 61 lessons in the prescription, 31 “core” and 30 “supplemental,” the study found that the average number completed was 33, with 52% of patients completing all 31 core lessons. Treatment retention at weeks 9 to 12 (counted as engaging with some aspect of the technology at least once) was 75%, including 55% at week 12. Around 62% of patients abstained at last four weeks, and that was using the conservative measure that considered missing data such as a positive urine test. According to the study, which abstinence the rate is higher than in the clinical trials that resulted in FDA approval of reSET, as well as in other PDT studies. Early and consistent participation was associated with higher rates of both retention and abstinence at the end of treatment: Of the 258 patients (43%) who fully followed the prescription to complete four or more lessons per week during the first four weeks, 92% were retained at 12 weeks and 82% were abstinent.

The study notes: “With only 6.5% of SUD patients receiving any treatment and high levels of attrition among patients receiving treatment, a therapy that can be conveniently used throughout the day (i.e., outside of regular clinic hours) and is associated with high engagement and retention rates, offers the potential to overcome existing limitations in addiction treatment programs.”

Additional Pear Medical Director, Yuri MaricichMD, “The high engagement and retention rates we observed in this analysis are particularly encouraging, as they demonstrate the potential benefit of reSET in treating patients in diverse, natural, real-world settings with substance use disorder, a population that needs effective therapies.”

From the Jama Network:
Emergency intervention can reduce binge drinking

Amid the often chaotic environment of an emergency room, clinicians treating a patient who arrives noticeably drunk may not consider the big picture and the potential for addressing long-term problems. alcohol use disorder (AUD). A study outside of Switzerland suggests that a minimally invasive intervention has the potential to positively influence the future behavior of young people with alcohol problems presenting to an emergency room.

“A brief motivational intervention model implemented in the emergency department among intoxicated young adults may have a beneficial effect on binge drinking, which is a major public health concern.”

—Swiss emergency study

The study followed 306 patients ages 18 to 34 who presented to an emergency department over a 30-month period for any cause and were diagnosed with alcohol intoxication. The typical intervention for such a patient would involve brief advice (BA), a recommendation to reduce alcohol consumption, and referrals to AUD services. The study looked at how a slightly longer motivational intervention (MI) (exploring the patient’s current situation, discussing possible futures, and planning for change) plus three follow-up booster sessions over the phone might influence long-term outcomes.

Patients were randomized to BA or MI interventions and were followed up at intervals of 1, 3, 6, and 12 months. The findings indicated that, although alcohol consumption did not decrease overall, patients in the motivational intervention had fewer days of heavy drinking, perhaps the most troublesome aspect of AUD, during the subsequent 12 months, compared with the group. of control. Additionally, patients in the MI group were more likely to seek AUD treatment. The study authors write: “These findings suggest that a brief motivational intervention model implemented in the emergency department among intoxicated young adults may have a beneficial effect on binge drinking, which is a major public health concern.”

Photos: Scripps Research

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