Immunotherapeutic strategies for treating opioid use disorder and overdose

ABSTRACT

Introduction

Development and implementation of effective treatments for opioid use disorder (OUD) and prevention of overdose are urgent public health needs. Though existing medications for OUD (MOUD) are effective, barriers to initiation and retention in treatment persist. Therefore, development of novel treatments, especially those may complement existing treatments, is needed.

Areas covered

This review provides an overview of vaccines for substance use disorders (SUD) and mechanisms underlying their function and efficacy. Next, we focus on existing preclinical and clinical trials of SUD vaccines. We focus briefly on related strategies before providing an expert opinion on prior, current, and future work on vaccines for OUD. We included published findings from preclinical and clinical trials found on PubMed and ScienceDirect as well as ongoing or initiated trials listed on ClinicalTrials.gov.

Expert opinion

The present opioid overdose and OUD crises necessitate urgent development and implementation of effective treatments, especially those that offer protection from overdose and can serve as adjuvants to existing medications. Promising preclinical trial results paired with careful efforts to develop vaccines that account for prior SUD vaccine shortcomings offer hope for current and future clinical trials of opioid vaccines. Clinical advantages of opioid vaccines appear to outnumber disadvantages, which may result in improved treatment options.

KEYWORDS:

• Vaccines
• immunotherapies
• opioid use disorder
• substance use disorders
• heroin
• oxycodone
• fentanyl
• opioids
• nicotine
• Cocaine

Article highlights

• Vaccines and immunotherapies offer some advantages as standalone and combined interventions for opioid use disorder [OUD]

• Extensive preclinical data support current candidate vaccines for OUD

• Further work is needed to extend preclinical findings to clinical trials, and efforts to address prior substance use disorder [SUD] vaccine shortcomings are important

Declaration of interest

R Luba discloses a NIDA T32 Post-Doctoral Fellowship in the Division of Substance Use Disorders at NYSPI/CUIMC.

S Martinez discloses a NIDA T32 Post-Doctoral Fellowship in the Division of Substance Use Disorders at NYSPI/ CUIMC.

J Jones discloses serving as a consultant to Alkermes; receiving an investigator-initiated grant from Merck Pharmaceuticals and the Peter McManus Charitable Trust; and receiving an honorarium from the World Health Organization.

M Pravetoni has filed patents disclosing composition and methods of use of vaccines and monoclonal antibodies for substance use disorders.

SD Comer has received research funding from Alkermes, BioXcel (NIDA grant and company-sponsored grant), Go Medical (NIDA grant), Intra-cellular Therapies (NIDA grant), Janssen, and Lyndra (NIDA grants); and in the past 3 years has consulted for Alkermes, Nektar, Opiant, and Otsuka.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

Funding was in the form of salary support for R Luba and S Martinez through NIDA T32 (DA007294-22) and salary support for M Pravetoni and SD Comer from NIDA (UG3DA047711).