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Table A17-1Methadone versus clonidine

Quality assessment
No of studiesDesignLimitationsConsistencyDirectnessOther considerations
Completion of treatment (Kleber 1985, San 1990, Umbricht 2003, Washton 1980)
4Randomised trialsNo limitationsNo important inconsistencyNo uncertaintyNone
Started naltrexone maintenance (Gerra 2000)
1Randomised trialsSerious limitations (−1)4No important inconsistencyNo uncertaintyImprecise or sparse data (−1)3
Abstinence during treatment (Kleber 1985)
1Randomised trialsNo limitationsNo important inconsistencyNo uncertaintyImprecise or sparse data (−1)3
Abstinence at endpoint (Kleber 1985, Washton 1980)
2Randomised trialsNo limitationsNo important inconsistencyNo uncertaintyImprecise or sparse data (−1)2
Abstinence at 1-month follow-up (Kleber 1985)
1Randomised trialsNo limitationsNo important inconsistencyNo uncertaintyImprecise or sparse data (−1)2,3
Abstinence at 3-month follow-up (Kleber 1985)
1Randomised trialsNo limitationsNo important inconsistencyNo uncertaintyImprecise or sparse data (−1)2,3
Abstinence at 6-month follow-up (Kleber 1985)
1Randomised trialsNo limitationsNo important inconsistencyNo uncertaintyImprecise or sparse data (−1)2,3
Self-rated withdrawal severity: peak (Kleber 1985. Better indicated by: lower scores)
1Randomised trialsNo limitationsNo important inconsistencyNo uncertaintyImprecise or sparse data (−1)3
Self-rated withdrawal severity: mean change from baseline (Umbricht 2003. Better indicated by: lower scores)
1Randomised trialsNo limitationsNo important inconsistencyNo uncertaintyImprecise or sparse data (−1)2,3
Adverse events: side effects rating (Kleber 1985, Washton 1982. Better indicated by: lower scores)
2Randomised trialsSerious limitations (−1)4No important inconsistencyNo uncertaintyVery strong association (+2)5
Summary of findings
OutcomeNo of patientsEffectQuality
MethadoneClonidineRelative (95% CI)Absolute (95% CI)
Completion of Treatment57/99 (57.6%)80/188 (42.6%)RR 1.5 (1.19 to 1.9)-[plus sign in circle][plus sign in circle][plus sign in circle][plus sign in circle]
High
Entry into naltrexone maintenance (methadone vs clonidine)9/34 (26.5%)17/32 (53.1%)RR 0.50 (0.26 to 0.95)-[plus sign in circle][plus sign in circle]○○
Low
Abstinence during treatment13/25 (52%)10/24 (41.7%)RR 1.25 (0.68 to 2.29)-[plus sign in circle][plus sign in circle][plus sign in circle]
Moderate
Abstinence at endpoint15/38 (39.5%)14/37 (37.8%)RR 1.04 (0.58 to 1.85)-[plus sign in circle][plus sign in circle][plus sign in circle]
Moderate
Abstinence at 1-month follow-up8/25 (32%)6/24 (25%)RR 1.28 (0.52 to 3.14)-[plus sign in circle][plus sign in circle][plus sign in circle]
Moderate
Abstinence at 3-month follow-up8/25 (32%)6/24 (25%)RR 1.28 (0.52 to 3.14)-[plus sign in circle][plus sign in circle][plus sign in circle]
Moderate
Abstinence at 6-month follow-up9/25 (36%)4/24 (16.7%)RR 2.16 (0.77 to 6.09)-[plus sign in circle][plus sign in circle][plus sign in circle]
Moderate
Self-rated withdrawal severity: peak2525-SMD −0.65 (−1.22 to −0.08)[plus sign in circle][plus sign in circle][plus sign in circle]
Moderate
Self-rated withdrawal severity: Mean change from baseline1818-SMD 0.25 (−0.4 to 0.91)[plus sign in circle][plus sign in circle][plus sign in circle]
Moderate
Adverse events: Side effects rating125125-SMD −0.92 (−1.18 to −0.66)[plus sign in circle][plus sign in circle][plus sign in circle][plus sign in circle]
High
1

Significant heterogeneity (I2 >= 50%)

2

CIs do not favour either treatment

3

Single study

4

No blinding

5

Large effect (SMD <= −0.8)

CIs do not favour either treatment

Single study

No blinding

Large effect (SMD <= −0.8)

From: APPENDIX 17, EVIDENCE PROFILE TABLES

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Drug Misuse: Opioid Detoxification.
NICE Clinical Guidelines, No. 52.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2008.
Copyright © 2008, The British Psychological Society & The Royal College of Psychiatrists.

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