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Background: The buprenorphine transdermal system (BTDS) is approved in the US for the management of chronic pain. Due to its high affinity for mu-opioid receptors with a slow dissociation profile, buprenorphine may potentially displace or prevent the binding of competing mu-opioid-receptor agonists, including immediate-release (IR) opioids, in a dose-dependent manner. Health care professionals may assume that the use of IR opioids for supplemental analgesia during BTDS therapy is not acceptable. Materials and methods: This post hoc analysis evaluated the use of IR opioids as supplemental analgesia during the management of moderate-severe chronic pain with BTDS at 52 US sites (BUP3015S, NCT01125917). Patients were categorized into IR-opioid and no-IR-opioid groups. At each visit of the extension phase, adverse events, concomitant medications, and information from the Brief Pain Inventory (BPI) were recorded. Results: The most common supplemental IR opioids prescribed during BTDS treatment (n=354) were hydrocodone-acetaminophen and oxycodone-acetaminophen. The mean daily dose of IR opioids (morphine equivalents) for supplemental analgesia was 22 mg. At baseline, BPI pain intensity and BPI - interference scores were higher for patients in the IR-opioid group. In both treatment groups, scores improved by week 4, and then were maintained throughout 6 months of the open-label extension trial. The incidence of treatment-emergent adverse events was similar in both groups. Conclusion: Patients who were prescribed IR opioids reported lower scores for BPI pain intensity and pain interference to levels similar to patients receiving BTDS without IR opioids, without increasing the rate or severity of treatment-emergent adverse events. Patients prescribed concomitant use of IR opioids with BTDS had greater treatment persistence. The results of this post hoc analysis provide support for the concomitant use of IR opioids for supplemental analgesia during the management of moderate-severe chronic pain with BTDS.

L'objectif principal de cette thèse est d'apporter une contribution à la modélisation de la cinétique de libération de principes actifs à partir de systèmes polymère-médicament, en tentant de réduire le "burst effect" et augmenter le temps de libération. L'idée de base est, dans un premier temps, l'encapsulation du médicament dans des liposomes, vésicules lipidiques capables de transporter le médicament, puis son inclusion dans des hydrogels polymères de manière à créer deux barrières dans le processus de libération du médicament. Les hydrogels sont à base de chitosane/gélatine et chitosane/poly(alcool vinylique) réticulés, partiellement avec de l'aldéhyde glutarique et de manière prédominante par voie ionique avec des anions sulfate ou polyphosphate. Une seconde catégorie est à base de chitosane, seul ou en combinaison avec le poly(alcool vinylique), réticulé avec de l'acide tannique à travers de nombreuses interactions hydrogène. Les hydrogels sont caractérisés d'une part par leur structure, leur morphologie, leur comportement en milieu aqueux et leur stabilité thermique; d'autre part leurs propriétés comme biomatériau (hémocompatibilité et cytotoxicité), leur capacité à inclure et libérer un composé modèle (la calcéine) libre ou encapsulé dans des liposomes. La dépendance de ces propriétés (gonflement, libération des composés solubles inclus) avec les paramètres du processus de préparation (quantité de réticulant, rapport ente les polymères utliisés, masse molaire du chitosane) est établie. Les études de cinétique de libération de la calcéine (incluse direment dans les hydrogels ou encapsulée dans les liposomes dispersés ensuite dans les hydrogels) prouve la pertinence de l'hypothèse de départ: quel que soit le type de réticulation employée pour la préparation des hydrogels, la libération de la calcéine à partir des systèmes complexes (hydrogel-liposomes-calcéine) est fortement retardée sans manifester de "burst effect". Le manuscrit conclut avec un chapitre de modélisation de la cinétique de libération à partir des systèmes employés. Etant données les applications potentielles de tels hydrogels sous forme de films pour traiter les affections de la peau, les résultats préliminaires de libération de lévofloxacine à partir d'un système transdermique qui simule les dermes humains sont montrés. / The main objective of the PhD thesis entitled “Complex polymeric biomaterials for modeling the drug release kinetics” was to bring contributions in modeling the release kinetics of active ingredients from polymer-drug systems, attempting to reduce the "burst effect"' and increase the release time. The basic idea of the thesis was, in a first stage, the encapsulation of the drug in liposomes -lipid vesicles capable of drug transport- and their subsequent inclusion in polymeric hydrogels in the rationale of creating two "barriers" in drug release process. First, obtained hydrogels are based on chitosan/gelatin and chitosan/poly(vinyl alcohol) partly covalently crosslinked with glutaraldehyde and dominantly ionically with anion sulfate or tripolyphosphate. A second category is based on chitosan hydrogels, alone or in combination with poly(vinyl alcohol), crosslinked with tannic acid through numerous hydrogen bonds. Hydrogels were characterized structurally, morphologically, in terms of the behavior in aqueous media and thermal stability, the qualities of biomaterial (hemocompatibility and cytotoxicity), the ability to include and release a model compound (calcein) free or encapsulated in liposomes. Dependence of properties (swelling, release of soluble compounds included) on the preparation process parameters (amount of crosslinker, polymers ratio used, chitosan molecular weight) is established. Performing calcein release kinetic studies (calcein included directly in hydrogels or encapsulated in liposomes subsequently dispersed in hydrogels) proves the correctness of the starting hypothesis: whatever type of crosslinking applied for the preparation of hydrogels, the release of calcein from complex systems (hydrogel-liposomes-calcein) is much delayed without manifesting practically "burst effect". The paper concludes with a chapter with modeling the release kinetics from the studied systems and with the Conclusions and Perspectives. Given the potential application of such hydrogels in the form of films for treating skin conditions, preliminary results of levofloxacin release from a transdermal system that simulates human dermis are shown.