Objective

2

To construct a predictive model for the reduction in methadone maintenance treatment (MMT) and evaluate the effects of different interventions and other clinical factors on methadone reduction using Shapley additive explanations (SHAP).

Methods

2

Two clinical trials of acupuncture for methadone reduction in MMT patients were analyzed

and the baseline data

MMT related information

intervention measures

the data related to dose-reduction outcomes were collected. The predictive model was constructed by means of 6 machine learning algorithms including support vector machine (SVM)

K-nearest neighbors (KNN)

logistic regression (LR)

Naive Bayes (NB)

random forest (RF) and categorical-boosting (CatBoost)

and 2 integration methods

blending-ensemble method (Blending) and Stacking-ensemble method (Stacking). SHAP was employed for the interpretability analysis of the optimal model.

Results

2

A total of 251 MMT patients were included

128 cases in the acupuncture group and 123 cases in the non-acupuncture group. CatBoost and Stacking performed optimally in the test set. CatBoost obtained an accuracy of 0.780 0±0.060 8

a precision of 0.500 0±0.120 0

a recall of 0.818 2±0.140 2

F1 score of 0.620 7±0.114 0

and receiver operating characteristic-area under curve (ROC-AUC) of 0.857 8±0.140 2 for the subjects. In MMT patients with acupuncture as an adjunctive therapy

the top 5 important features for methadone reduction

included intervention measures

body mass index (BMI)

the duration of MMT

the history of opioid use and occupation; and SHAP values were 1.25

0.36

0.21

0.19 and 0.12

respectively. The SHAP feature dependence plot showed that BMI

MMT duration and the history of opioid use presented a nonlinear negative correlation with the reduction effect.

Conclusion

2

In acupuncture as adjunctive therapy for methadone reduction

the clinical factors should be considered comprehensively; and the interpretable predictive model provides a scientific basis for it

which is conducive to the improvement of clinical strategy of acupuncture for methadone reduction and the development of personalized reduction scheme.