The Risk Assessment Before Dose Tapering Among Methadone Maintenance Treatment Participants: Derivation and Validation of a Nomogram.

Abstract

Many methadone maintenance treatment (MMT) participants experienced a tapering phase. The benefit of tapering is based on a balance between meeting the desire to reduce methadone dose and reduction in relapse. We aimed to develop and validate a nomogram to assess relapse risk after dose tapering. We developed and internally validated a nomogram for risk assessment before dose tapering in 432 participants with dose tapering in the non-Guangzhou region of Guangdong, China, and externally validated it in 117 participants with dose tapering in Guangzhou. Cox regression analysis showed that the taper start week (HR = 0.14, [0.08-0.22]) was an independent risk predictor of the relapse risk after tapering. The C-index of the nomogram was 0.76 (95%CI: 0.73-0.79) in the training cohort, 0.76 (95%CI: 0.72-0.80) in the testing cohort, and 0.84 (95%CI: 0.80-0.88) in the validation cohort. Decision curve analysis showed that the nomogram had better discriminative ability than other predictors. The nomogram was developed to assess the risk of relapse for MMT participants who volunteer a tapering phase and may help participants better make decisions about whether and how to reduce the dose to minimize the harm of relapse.