1
|
Almutairi AB, Alrashdi NZ, Vogtle L, Alotaibi MM. Effect of psychostimulant medications on physical function in children with cerebral palsy: scoping review. Pediatr Res 2024; 95:1217-1223. [PMID: 38071277 DOI: 10.1038/s41390-023-02933-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/18/2023] [Accepted: 11/14/2023] [Indexed: 04/24/2024]
Abstract
The aim of this scoping review is to examine the extent and depth of the literature on effects of central nervous system (CNS) stimulant medications on physical function in children with cerebral palsy (CP). A systematic search for relevant peer-reviewed studies was conducted of PubMed, CINAHL, Cochrane, SPORTDiscus, Embase, & Scopus (January 2002 & August 2022). We included studies that examined the effects of CNS stimulants on physical function in children with CP. Four studies met our selection criteria. All studies explored the effect of Modafinil on physical function outcomes. Three studies of the four included studies reported positive effects of Modafinil on spasticity, motor performance, and gait, whereas one study reported no significant effects of Modafinil. Our findings suggest that there is very low-quality evidence that suggests that Modafinil may enhance physical improvements in body structure and function, including reduction in spasticity and improvements in gait parameters. IMPACT: Central nervous system stimulants were examined for efficacy on physical function and spasticity in children with cerebral palsy. The evidence on the effects of central nervous system stimulants on physical function in children with CP is limited and inconsistent.
Collapse
Affiliation(s)
- Anwar B Almutairi
- Department of Physical Therapy, Faculty of Allied Health, Kuwait University, Jabriya, Kuwait.
| | - Naif Z Alrashdi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Laura Vogtle
- Department of Occupational Therapy, School of Health Professions, Birmingham, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mansour M Alotaibi
- Department of Rehabilitation, Faculty of Applied Medical Sciences, Northern Border University, Arar, Saudi Arabia
| |
Collapse
|
2
|
Alotaibi M, Almutairi AB, Alhirsan S, Alkazemi A, Alharbi M, Alrashdi N, Taqi A, Alamiri B, Vogtle L, Alqahtani MM. Psychostimulant Medications for Physical Function and Spasticity in Children With Cerebral Palsy: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e53728. [PMID: 38441919 PMCID: PMC10951828 DOI: 10.2196/53728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Cerebral palsy (CP) is a prevalent nonprogressive disorder that leads to impaired movement (ie, spasticity), posture, and balance, which affects functions such as walking and upper extremity tasks. Current medical treatments show efficacy in improving motor performance but have considerable side effects. Emerging off-label use of central nervous system (CNS) medications for improving motor performance has shown promising results in children with CP and other populations. OBJECTIVE The aim of this study is to describe a protocol for a pilot randomized controlled trial (RCT) to examine the safety, tolerability, and efficacy of methylphenidate (MPH) and modafinil on spasticity and motor performance in children with CP. METHODS This will be a protocol study for a pilot, triple-masked, placebo-controlled RCT (a class I trial following the American Academy of Neurology criteria) with blinded patients, outcome assessors, and intervention delivery team. Eligible children should be diagnosed with CP levels I or II based on the Gross Motor Function Classification System and be aged between 7 and 12 years. Thirty-six children with CP will be randomized into 3 groups to receive (1) MPH (2.5 mg of MPH + 100 mg placebo), (2) modafinil (100 mg modafinil + 2.5 mg placebo), or (3) a placebo (2.5 mg placebo + 100 mg placebo), in addition to physical therapy for 12 weeks. Primary outcomes include the Gross Motor Function Measure-66 and the Modified Ashworth Scale. Secondary outcomes include the Timed Up and Go test, 5 Time Sit to Stand test, Modified Clinical Test for Sensory Interaction of Balance, and 10-Meter Walk Test. RESULTS The protocol has been accepted by Kuwait University (VDR/EC-225) and the Ministry of Health of Kuwait (2022/2157). The inclusion of participants will start in June 2024. CONCLUSIONS The combination of CNS stimulant medications and controlling for rehabilitation has not been studied yet. The findings of this study may determine if using CNS stimulant medications is beneficial for the reduction of spasticity and improvement of physical function in children with spastic CP. TRIAL REGISTRATION ClinicalTrials.gov NCT05675098; https://clinicaltrials.gov/study/NCT05675098. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/53728.
Collapse
Affiliation(s)
- Mansour Alotaibi
- Department of Rehabilitation, Faculty of Applied Medical Sciences, Northern Border University, Arar, Saudi Arabia
- Center for Health Research, Northern Border University, Arar, Saudi Arabia
| | - Anwar B Almutairi
- Department of Physical Therapy, Faculty of Allied Health, Kuwait University, Kuwait City, Kuwait
| | - Saleh Alhirsan
- Department of Physical Therapy, College of Applied Medical Sciences, Jouf University, Aljouf, Saudi Arabia
| | - Afrah Alkazemi
- Department of Pharmacy Practice, College of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Maha Alharbi
- Department of Pharmacy Practice, College of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Naif Alrashdi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
- The Health and Scientific Research Center, Majmaah University, Majmaah, Saudi Arabia
| | - Ahmad Taqi
- Department of Pharmacy Practice, College of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Bibi Alamiri
- Kuwait Center for Mental Health, Public Authority for Disability Affairs, Almanara, Kuwait
| | - Laura Vogtle
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mohammed M Alqahtani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Moharram M, Kiang T. Pharmacokinetics of Long-Acting Methylphenidate: Formulation Differences, Bioequivalence, Interchangeability. Eur J Drug Metab Pharmacokinet 2024; 49:149-170. [PMID: 38127227 DOI: 10.1007/s13318-023-00873-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND OBJECTIVE: Attention deficit hyperactivity disorder is one of the most common neuropsychiatric conditions in children, and methylphenidate (MPH) is one of the first-line therapies. MPH is available in a variety of extended-release (ER) formulations worldwide, and most formulations are not considered bioequivalent due to differences in pharmacokinetics. It is hypothesized that the current bioequivalence guidelines from the different regulatory bodies may generate inconsistent findings or recommendations when assessing the bioequivalence of ER MPH formulations. This manuscript aims to conduct a comprehensive and narrative critical literature review to analyze pharmacokinetic data pertaining to ER formulations of MPH in order to assess bioequivalence, differences in regulatory guidelines, and additional pharmacokinetic-pharmacodynamic parameters that may help define interchangeability. METHODS A literature search was conducted in EMBASE, Medline, and Cochrane Library with no time limits. Study characteristics, non-compartmental pharmacokinetic parameters, and bioequivalence data were extracted for analysis. RESULTS Thirty-three studies were identified with primary pharmacokinetic data after the administration of ER MPH, of which 10 were direct comparative studies (i.e., at least 2 formulations tested within a single setting) and 23 were indirect comparisons (i.e., different experimental settings). Two formulations were consistently reported as bioequivalent across the regulatory bodies using criteria from their guidance documents, although inconsistencies have been observed. However, when additional kinetic criteria (discussed in this manuscript) were imposed, only one study met the more stringent definition of bioequivalence. Various clinical factors also had inconsistent effects on the pharmacokinetics and interchangeability of the different formulations, which were associated with a lack of standardization for assessing covariates across the regulatory agencies. CONCLUSION Additional pharmacokinetic parameters and consistency in guidelines across the regulatory bodies may improve bioequivalence assessments. Based on our findings, more research is also required to understand whether bioequivalence is an appropriate measure for determining MPH interchangeability. This critical review is suitable for formulation scientists, clinical pharmacologists, and clinicians.
Collapse
Affiliation(s)
- Mostafa Moharram
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3-142D (Office), 3081 (Lab) Katz Group Centre for Research, 11315, 87 Ave NW, Edmonton, AB, T6G 2H5, Canada
| | - Tony Kiang
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3-142D (Office), 3081 (Lab) Katz Group Centre for Research, 11315, 87 Ave NW, Edmonton, AB, T6G 2H5, Canada.
| |
Collapse
|
4
|
Tanana L, Latif A, Nishtala PS, Chen TF. Investigating Variations in Medicine Approvals for Attention-Deficit/Hyperactivity Disorder: A Cross-Country Document Analysis Comparing Drug Labeling. J Atten Disord 2024:10870547231224088. [PMID: 38327043 DOI: 10.1177/10870547231224088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE This study aimed to compare the approval of medicines for attention deficit/hyperactivity disorder (ADHD) for pediatric patients across five countries. METHOD A document analysis was completed, using the drug labeling for ADHD medicines from five countries; United Kingdom, Australia, New Zealand, Canada and United States (US). Comparisons of available formulations and approval information for ADHD medicine use in pediatric patients were made. RESULTS The US had the highest number of approved medicines and medicine forms across the studied countries (29 medicine forms for 10 approved medicines). Approved age and dosage variations across countries and missing dosage information were identified in several drug labeling. CONCLUSIONS The discrepancies in approval information in ADHD medicine drug labeling and differing availability of medicine formulations across countries suggest variations in the management of ADHD across countries. The update of drug labeling and further research into reasons for variability and impact on practice are needed.
Collapse
Affiliation(s)
- Laila Tanana
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Asam Latif
- University of Nottingham, Nottingham, UK
| | | | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
5
|
Smith MCF, Mukherjee RAS, Müller-Sedgwick U, Hank D, Carpenter P, Adamou M. UK adult ADHD services in crisis. BJPsych Bull 2024; 48:1-5. [PMID: 38058161 PMCID: PMC10801359 DOI: 10.1192/bjb.2023.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/26/2023] [Accepted: 10/12/2023] [Indexed: 12/08/2023] Open
Abstract
The UK's services for adult attention-deficit hyperactivity disorder (ADHD) are in crisis, with demand outstripping capacity and waiting times reaching unprecedented lengths. Recognition of and treatments for ADHD have expanded over the past two decades, increasing clinical demand. This issue has been exacerbated by the COVID-19 pandemic. Despite an increase in specialist services, resource allocation has not kept pace, leading to extended waiting times. Underfunding has encouraged growth in independent providers, leading to fragmentation of service provision. Treatment delays carry a human and financial cost, imposing a burden on health, social care and the criminal justice system. A rethink of service procurement and delivery is needed, with multiple solutions on the table, including increasing funding, improving system efficiency, altering the service provision model and clinical prioritisation. However, the success of these solutions hinges on fiscal capacity and workforce issues.
Collapse
Affiliation(s)
| | | | | | - Dietmar Hank
- Avon & Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Peter Carpenter
- University of Bristol, Bristol, UK
- Royal College of Psychiatrists, London, UK
| | - Marios Adamou
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
- University of Huddersfield, Huddersfield, UK
| |
Collapse
|
6
|
Katzman MA, Otcheretko V, Po MD, Uchida CL, Incledon B. Adverse Events During Dosing of Delayed-release/Extended-release Methylphenidate: Learnings From the Open-label Phase of a Registration Trial and a Real-world Postmarketing Surveillance Program. Clin Ther 2023; 45:1212-1221. [PMID: 37770309 DOI: 10.1016/j.clinthera.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE Delayed-release/extended-release methylphenidate (DR/ER-MPH) (formerly HLD200) is an evening-dosed agent used for the treatment of attention-deficit/hyperactivity disorder. Postmarketing surveillance data from approximately 74,000 patients exposed to DR/ER-MPH (up to June 17, 2022) were reported and compared with the open-label, treatment-optimization phase of a Phase III clinical trial to derive possible learnings on how to approach adverse events (AEs) that emerge during dose titration. METHODS An analysis of AEs spontaneously reported to Ironshore in postmarketing surveillance included, where available, age, dose, timing, and discontinuations. Data were summarized using descriptive statistics. FINDINGS A total of 395 children, adolescents, and adults reported 601 AEs in postmarketing surveillance. Five AEs were classified as serious. AEs preceded drug use discontinuation in 172 patients. Many AEs occurred early (52% were reported within 30 days) and at lower doses (54% were reported at 20 to 40 mg), similar to the trial data. Reported AEs included those similar in type but orders of magnitude lower in number than those from the clinical trial. IMPLICATIONS No new safety concerns were revealed in this real-world setting compared with the safety profile identified in DR/ER-MPH trial data. In real-world practices, clinicians tended to discontinue DR/ER-MPH treatment after AE onset, whereas trial investigators continued to optimize treatment and found that AEs were generally tolerable, suggesting that health care practitioners may consider developing strategies to manage tolerability issues with DR/ER-MPH treatment on AE emergence rather than immediately discontinuing use of the drug to provide optimal therapeutic benefit. CLINICALTRIALS gov identifier: NCT02493777.
Collapse
Affiliation(s)
- Martin A Katzman
- S.T.A.R.T. Clinic for Mood and Anxiety Disorders, Toronto, Ontario, Canada; Northern Ontario School of Medicine, Sudbury, Ontario, Canada; Lakehead University, Thunder Bay, Ontario, Canada; Adler Graduate Professional School, Toronto, Ontario, Canada.
| | | | | | | | | |
Collapse
|
7
|
Merrill BM, Macphee FL, Burrows-MacLean L, Coles EK, Wymbs BT, Chacko A, Walker K, Wymbs F, Garefino A, Robb Mazzant J, Gnagy EM, Waxmonsky JG, Massetti GM, Waschbusch DA, Fabiano GA, Pelham WE. Single and Combined Effects of Multiple Intensities of Behavioral Modification and Methylphenidate for Children with ADHD in the Home Setting. Res Child Adolesc Psychopathol 2023; 51:1481-1495. [PMID: 37382748 PMCID: PMC11103974 DOI: 10.1007/s10802-023-01093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
Behavioral treatment, stimulants, and their combination are the recommended treatments for childhood attention-deficit/hyperactivity disorder (ADHD). The current study utilizes within-subjects manipulations of multiple doses of methylphenidate (placebo, 0.15, 0.30, and 0.60 mg/kg/dose t.i.d.) and intensities of behavioral modification (no, low, and high intensity) in the summer treatment program (STP) and home settings. Outcomes are evaluated in the home setting. Participants were 153 children (ages 5-12) diagnosed with ADHD. In alignment with experimental conditions implemented during the STP day, parents implemented behavioral modification levels in three-week intervals, child medication status varied daily, and the orders were randomized. Parents provided daily reports of child behavior, impairment, and symptoms and self-reported parenting stress and self-efficacy. At the end of the study, parents reported treatment preferences. Stimulant medication led to significant improvements across all outcome variables with higher doses resulting in greater improvement. Behavioral treatment significantly improved child individualized goal attainment, symptoms, and impairment in the home setting and parenting stress and self-efficacy. Effect sizes indicate that behavioral treatment combined with a low-medium dose (0.15 or 0.30 mg/kg/dose) of medication results in equivalent or superior outcomes compared to a higher dose (0.60 mg/kg/dose) of medication alone. This pattern was seen across outcomes. Parents overwhelmingly reported preferring treatment with a behavioral component as a first-choice treatment (99%). Results underscore the need to consider dosing as well as parent preference when utilizing combined treatment approaches. This study provides further evidence that combining behavioral treatment and stimulant medication may reduce the stimulant dose needed for beneficial effects.
Collapse
Affiliation(s)
- Brittany M Merrill
- Center for Children and Families, Florida International University, Buffalo, NY, USA.
| | - Fiona L Macphee
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | | | - Erika K Coles
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | - Brian T Wymbs
- Department of Psychology, Ohio University, Athens, OH, USA
| | - Anil Chacko
- Department of Applied Psychology, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA
| | | | - Frances Wymbs
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Allison Garefino
- Department of Psychology, Kennesaw State University, Kennesaw, GA, USA
| | - Jessica Robb Mazzant
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | - Elizabeth M Gnagy
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | - James G Waxmonsky
- Department of Psychiatry, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Greta M Massetti
- State University of New York at Buffalo, Buffalo, NY, USA
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniel A Waschbusch
- Department of Psychiatry, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Gregory A Fabiano
- Center for Children and Families, Florida International University, Buffalo, NY, USA
| | - William E Pelham
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA.
| |
Collapse
|
8
|
Storebø OJ, Storm MRO, Pereira Ribeiro J, Skoog M, Groth C, Callesen HE, Schaug JP, Darling Rasmussen P, Huus CML, Zwi M, Kirubakaran R, Simonsen E, Gluud C. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev 2023; 3:CD009885. [PMID: 36971690 PMCID: PMC10042435 DOI: 10.1002/14651858.cd009885.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children and adolescents with ADHD find it difficult to pay attention and they are hyperactive and impulsive. Methylphenidate is the psychostimulant most often prescribed, but the evidence on benefits and harms is uncertain. This is an update of our comprehensive systematic review on benefits and harms published in 2015. OBJECTIVES To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two trials registers up to March 2022. In addition, we checked reference lists and requested published and unpublished data from manufacturers of methylphenidate. SELECTION CRITERIA We included all randomised clinical trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. The search was not limited by publication year or language, but trial inclusion required that 75% or more of participants had a normal intellectual quotient (IQ > 70). We assessed two primary outcomes, ADHD symptoms and serious adverse events, and three secondary outcomes, adverse events considered non-serious, general behaviour, and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently conducted data extraction and risk of bias assessment for each trial. Six review authors including two review authors from the original publication participated in the update in 2022. We used standard Cochrane methodological procedures. Data from parallel-group trials and first-period data from cross-over trials formed the basis of our primary analyses. We undertook separate analyses using end-of-last period data from cross-over trials. We used Trial Sequential Analyses (TSA) to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the GRADE approach. MAIN RESULTS We included 212 trials (16,302 participants randomised); 55 parallel-group trials (8104 participants randomised), and 156 cross-over trials (8033 participants randomised) as well as one trial with a parallel phase (114 participants randomised) and a cross-over phase (165 participants randomised). The mean age of participants was 9.8 years ranging from 3 to 18 years (two trials from 3 to 21 years). The male-female ratio was 3:1. Most trials were carried out in high-income countries, and 86/212 included trials (41%) were funded or partly funded by the pharmaceutical industry. Methylphenidate treatment duration ranged from 1 to 425 days, with a mean duration of 28.8 days. Trials compared methylphenidate with placebo (200 trials) and with no intervention (12 trials). Only 165/212 trials included usable data on one or more outcomes from 14,271 participants. Of the 212 trials, we assessed 191 at high risk of bias and 21 at low risk of bias. If, however, deblinding of methylphenidate due to typical adverse events is considered, then all 212 trials were at high risk of bias. PRIMARY OUTCOMES methylphenidate versus placebo or no intervention may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.74, 95% confidence interval (CI) -0.88 to -0.61; I² = 38%; 21 trials; 1728 participants; very low-certainty evidence). This corresponds to a mean difference (MD) of -10.58 (95% CI -12.58 to -8.72) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points). The minimal clinically relevant difference is considered to be a change of 6.6 points on the ADHD-RS. Methylphenidate may not affect serious adverse events (risk ratio (RR) 0.80, 95% CI 0.39 to 1.67; I² = 0%; 26 trials, 3673 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 0.91 (CI 0.31 to 2.68). SECONDARY OUTCOMES methylphenidate may cause more adverse events considered non-serious versus placebo or no intervention (RR 1.23, 95% CI 1.11 to 1.37; I² = 72%; 35 trials 5342 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 1.22 (CI 1.08 to 1.43). Methylphenidate may improve teacher-rated general behaviour versus placebo (SMD -0.62, 95% CI -0.91 to -0.33; I² = 68%; 7 trials 792 participants; very low-certainty evidence), but may not affect quality of life (SMD 0.40, 95% CI -0.03 to 0.83; I² = 81%; 4 trials, 608 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS The majority of our conclusions from the 2015 version of this review still apply. Our updated meta-analyses suggest that methylphenidate versus placebo or no-intervention may improve teacher-rated ADHD symptoms and general behaviour in children and adolescents with ADHD. There may be no effects on serious adverse events and quality of life. Methylphenidate may be associated with an increased risk of adverse events considered non-serious, such as sleep problems and decreased appetite. However, the certainty of the evidence for all outcomes is very low and therefore the true magnitude of effects remain unclear. Due to the frequency of non-serious adverse events associated with methylphenidate, the blinding of participants and outcome assessors is particularly challenging. To accommodate this challenge, an active placebo should be sought and utilised. It may be difficult to find such a drug, but identifying a substance that could mimic the easily recognised adverse effects of methylphenidate would avert the unblinding that detrimentally affects current randomised trials. Future systematic reviews should investigate the subgroups of patients with ADHD that may benefit most and least from methylphenidate. This could be done with individual participant data to investigate predictors and modifiers like age, comorbidity, and ADHD subtypes.
Collapse
Affiliation(s)
- Ole Jakob Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | | | - Maria Skoog
- Clinical Study Support, Clinical Studies Sweden - Forum South, Lund, Sweden
| | - Camilla Groth
- Pediatric Department, Herlev University Hospital, Herlev, Denmark
| | | | | | | | | | - Morris Zwi
- Islington Child and Adolescent Mental Health Service, Whittington Health, London, UK
| | - Richard Kirubakaran
- Cochrane India-CMC Vellore Affiliate, Prof. BV Moses Centre for Evidence Informed Healthcare and Health Policy, Christian Medical College, Vellore, India
| | - Erik Simonsen
- Research Unit, Mental Health services, Region Zealand Psychiatry, Roskilde, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
9
|
Sandersleben HUV, Mayer A, Ruhmann M, Dangel O, Schütz H. Pharmacokinetics of a Modified-Release Dexamphetamine Sulfate Formulation Following Single and Multiple Dosing in Healthy Adults: Comparative Bioavailability with Immediate-Release Dexamphetamine Sulfate, between Strengths, Assessment of Food and Meal Composition Effects. Scand J Child Adolesc Psychiatr Psychol 2023; 11:132-142. [PMID: 38033826 PMCID: PMC10687392 DOI: 10.2478/sjcapp-2023-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Background A modified-release dexamphetamine sulfate formulation (DEX-MR) is under development for the treatment of attention-deficit/hyperactivity disorder. Objective We investigated the bioequivalence of once-daily DEX-MR to twice-daily immediate-release dexamphetamine sulfate (DEX-IR) after single and multiple dosing and between strengths, and effects of food and meal types. Method Three randomized, open-label, crossover studies in healthy males were conducted. In the single-dose study, participants received DEX-MR 20 mg, DEX-MR 10 mg (20 mg dose), and twice-daily DEX-IR 10 mg under fasted conditions and after a high-fat, high-calorie breakfast. In the breakfast study, participants received DEX-MR 20 mg and twice-daily DEX-IR 10 mg after a normocaloric and a high-fat, high-calorie breakfast. In the multiple-dose study, participants received DEX-MR 20 mg and twice-daily DEX-IR 10 mg for seven days each. In the run-in period (five days), participants consumed a normocaloric breakfast; on profile days, participants consumed a normocaloric breakfast (day 6) or a high-fat, high-calorie breakfast (day 7). Results Once-daily DEX-MR at a dose of 20 mg was bioequivalent to twice-daily DEX-IR 10 mg after single dosing under fasted and fed conditions and after multiple dosing under fed conditions. DEX-MR 10 mg and DEX-MR 20 mg were bioequivalent when administered as a single 20 mg dose. Food slightly reduced the rate and extent of absorption of DEX-MR and delayed the time to peak plasma concentration (tmax) by approximately two hours compared to the fasted state. Bioavailability of DEX-MR was comparable under different meal conditions (normocaloric vs. high-fat, high-calorie breakfast) both after single and multiple dosing. Conclusions Bioequivalence of once-daily DEX-MR and twice-daily DEX-IR was established. 1×2 DEX-MR 10 mg was bioequivalent to 1×1 DEX-MR 20 mg. DEX-MR should be administered with/after a meal to achieve the targeted pharmacokinetic profile (delayed tmax). Bioavailability of DEX-MR is not affected by meal composition (i.e., fat and caloric content).
Collapse
Affiliation(s)
- Henrik Uebel-von Sandersleben
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Anke Mayer
- Medical Department, MEDICE Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Michaela Ruhmann
- Medical Department, MEDICE Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Oliver Dangel
- Medical Department, MEDICE Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Helmut Schütz
- BEBAC – Consultancy Services for Bioequivalence and Bioavailability Studies, Vienna, Austria
- Center for Medical Data Science of the Medical University of Vienna, Vienna, Austria
| |
Collapse
|
10
|
Reciprocal effects of single or repeated exposure to methylphenidate or sex in adult male rats. Psychopharmacology (Berl) 2023; 240:227-237. [PMID: 36544054 DOI: 10.1007/s00213-022-06300-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE Exposure to rewards can alter behavioral reactivity to them. For example, stimulants sensitize locomotor activation, whereas sexual experience sensitizes copulatory behaviors. Moreover, rewards can cross-sensitize one another. Although stimulants are known to cross-sensitize locomotor effects, the evidence for cross-sensitization between stimulants and sex is less clear. OBJECTIVES This study determined the effects of single and repeated pre-exposure to methylphenidate (MPH) or sex on one another in adult male rats. METHODS Cross-sensitization between MPH (5 mg/kg) and sex (30 min with sexually experienced female) was examined. Adult male rats were pre-exposed to 0, 1, or 10 trials of either sex or MPH before being exposed to the other reward. Locomotor chambers were used in MPH trials. Bilevel chambers were used in sexual trials, and sexual behaviors were video scored. RESULTS The amount of prior sexual experience differentially influenced the ceiling of MPH-dependent sensitization; in the last drug trial, locomotion was highest in males given 1 previous sexual trial compared with 0 or 10. Compared with MPH-naive males, pre-exposure to MPH (1 and 10 trials) reduced the number of ejaculations without impacting sexual performance (intromission/mount latency and frequency). CONCLUSIONS These findings indicate that the degree of pre-exposure to a reward can differentially affect reactivity to novel rewards. The results showed that previous findings of cross-sensitization between amphetamine and sex do not extend to MPH. However, exposure to MPH prior to sexual experience can increase the amount of sexual stimulation needed to achieve ejaculation.
Collapse
|
11
|
Ono KE, Bearden DJ, Lee SM, Moss C, Kheder A, Cernokova I, Drane DL, Gedela S. Interventions for ADHD in children & adolescents with epilepsy: A review and decision tree to guide clinicians. Epilepsy Behav 2022; 135:108872. [PMID: 36037580 PMCID: PMC10084711 DOI: 10.1016/j.yebeh.2022.108872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common pediatric epilepsy comorbidities. Treating ADHD in the context of epilepsy can be overwhelming for parents and clinicians. Current frontline treatment for ADHD is stimulant medication. However, some parents of pediatric patients with epilepsy have concerns about adding additional medication to their child's epilepsy regimen and/or about adverse effects of stimulant medication. Non-medication ADHD treatments including psychosocial interventions and ketogenic diet have also shown success in improving ADHD symptoms. Our focused review provides an easy-to-use guide for clinicians on ADHD interventions and combinations of interventions for pediatric patients with epilepsy and ADHD. Our guide includes information from 8 electronic databases for peer-reviewed, English language studies of psychosocial treatments for youth with epilepsy and ADHD. One hundred eight studies were selected based on inclusion criteria (21 systematic reviews, 12 meta-analyses, 8 literature reviews, 6 population surveys, 31 clinical trials, 20 cross-sectional studies, and 10 retrospective reviews). Results indicated that stimulant medication is a frontline treatment for ADHD symptoms in youth with epilepsy, with important caveats and alternatives.
Collapse
Affiliation(s)
- Kim E Ono
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA, United States; Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States.
| | - Donald J Bearden
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA, United States; Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Susan M Lee
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA, United States; Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, U United States
| | - Cierra Moss
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Ammar Kheder
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Ivana Cernokova
- Department of Clinical Psychology, University of North Texas, Denton, TX, United States
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Department of Neurology University of Washington School of Medicine, Seattle, WA, United States
| | - Satyanarayana Gedela
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA, United States; Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| |
Collapse
|
12
|
Park EJ, Park YM, Lee SH, Kim B. The Loudness Dependence of Auditory Evoked Potentials is associated with the Symptom Severity and Treatment in Boys with Attention Deficit Hyperactivity Disorder. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2022; 20:514-525. [PMID: 35879036 PMCID: PMC9329111 DOI: 10.9758/cpn.2022.20.3.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 01/20/2022] [Accepted: 02/02/2022] [Indexed: 11/18/2022]
Abstract
Objective Methods Results Conclusion
Collapse
Affiliation(s)
- Eun Jin Park
- Department of Psychiatry, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Young-Min Park
- Department of Psychiatry, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Bongseog Kim
- Department of Psychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea
| |
Collapse
|
13
|
Incledon B, Incledon C, Gomeni R, Uchida CL, Morris A, Perry K, Kapuscinski J. Effect of Colonic Absorption on the Pharmacokinetic Properties of Delayed-Release and Extended-Release Methylphenidate: In Vivo, In Vitro, and Modeling Evaluations. Clin Pharmacol Drug Dev 2022; 11:966-975. [PMID: 35316579 PMCID: PMC9541386 DOI: 10.1002/cpdd.1089] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/13/2022] [Indexed: 11/07/2022]
Abstract
Most stimulants used to treat attention‐deficit/hyperactivity disorder are administered in the morning and absorbed in the upper gastrointestinal tract. DR/ER‐MPH (formerly HLD200), an evening‐dosed delayed‐release and extended‐release methylphenidate, is predicted to be absorbed in the proximal colon. The pharmacokinetic (PK) profile of DR/ER‐MPH is characterized by an 8‐ to 10‐hour delay in initial methylphenidate absorption and a subsequent gradual increase in plasma concentration, followed by a slow decline. To examine the relationship of absorption site to pharmacokinetics, the DR/ER‐MPH formulation was altered to release methylphenidate in the small intestine and distal colon. The 3 formulations were administered in an open‐label, 3‐way, crossover study in healthy adults (N = 18). Compared with the small intestine formulation, the PK profile of the proximal colon (DR/ER‐MPH) formulation exhibited a longer delay before initial methylphenidate absorption, decreased peak methylphenidate concentration, increased time to peak concentration, and decreased bioavailability; these characteristics were amplified in the distal colon formulation. Safety profiles fell within the expectations for methylphenidate products. Modeled PK profiles were similar between the small intestine formulation and a morning‐dosed extended‐release methylphenidate (both predicted to release methylphenidate in the upper gastrointestinal tract), providing additional evidence that the PK profile of DR/ER‐MPH is shaped by colonic absorption.
Collapse
Affiliation(s)
- Bev Incledon
- Ironshore Pharmaceuticals & Development, Inc.Camana BayGrand CaymanCayman Islands
| | - Chantal Incledon
- Ironshore Pharmaceuticals & Development, Inc.Camana BayGrand CaymanCayman Islands
| | | | | | | | - Kim Perry
- Innovative AnalyticsKalamazooMichiganUSA
| | - Jill Kapuscinski
- Ironshore Pharmaceuticals & Development, Inc.Camana BayGrand CaymanCayman Islands
| |
Collapse
|
14
|
Xia Y, Gong Y, Wang H, Li S, Mao F. Family Function Impacts Relapse Tendency in Substance Use Disorder: Mediated Through Self-Esteem and Resilience. Front Psychiatry 2022; 13:815118. [PMID: 35237192 PMCID: PMC8882822 DOI: 10.3389/fpsyt.2022.815118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/20/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Substance abuse has been a public health concern, and even after detoxification treatment, the relapse rate is still high. Family function is closely related to substance dependence. However, studies on psychological mechanisms between them are rare. OBJECTIVES We aimed to explore the mediating role of self-esteem and resilience in the pathway that family function impacts the relapse tendency among patients with substance use disorder (SUD). METHODS A total of 282 SUD patients were recruited, and standard questionnaires were administered for each patient. The relapse tendency, family function, self-esteem and resilience were assessed by the family care index questionnaire, the Connor-Davidson resilience scale, the Rosenberg self-esteem scale and the relapse tendency questionnaire. Bootstrap method was conducted for mediation analysis to test the effects of how family function affects relapse tendency mediated through self-esteem and resilience. RESULTS The average score of relapse tendency of the patients was 28.47 (SD = 11.89). Intermediary analysis found that self-esteem played an intermediary role in the relationship between family function and relapse tendency. Resilience plays an intermediary role in the relationship between family function and relapse tendency. Further, the path analysis showed that family function not only had a direct association with relapse tendency, but also indirectly related to relapse tendency through self-esteem and resilience. CONCLUSIONS Self-esteem and resilience are the key factors in the relationship between family function and relapse tendency of SUD patients.
Collapse
Affiliation(s)
- Yuwei Xia
- Department of Psychiatry and Psychology, College of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Yu Gong
- Department of Psychiatry and Psychology, College of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Hanbin Wang
- Department of Mathematics, Ximou Primary School, Yantai, China
| | - Shen Li
- Department of Psychiatry and Psychology, College of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Fuqiang Mao
- Department of Psychiatry and Psychology, College of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| |
Collapse
|
15
|
Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental condition associated with impaired function and increased risk of poor outcomes in children, young people and adults with the condition. Currently approved pharmacological treatments for ADHD include a range of stimulant (methylphenidate, amphetamine) and nonstimulant (atomoxetine, guanfacine, clonidine) medications. All have been shown to be effective in treating the symptoms of ADHD and improving other functional outcomes including quality of life, academic performance, rates of accidents and injuries, and do not appear to be associated with significant adverse outcomes or side effects. In this chapter, we review medications for ADHD by summarising the mechanisms of action of each of the two main classes of compounds (stimulants and nonstimulants), the formulations of the most commonly prescribed medications within each class, their efficacy in treating ADHD symptoms and other outcomes, and other factors that influence treatment decisions including side effects and tolerability, comorbidities and medical history. We conclude with a summary of the treatment decisions made by clinicians and suggest some next steps for research. Further research is needed to understand the mechanisms of action of these medications and how exactly they improve symptoms, and to examine their effects on commonly occurring comorbidities.
Collapse
Affiliation(s)
- Madeleine J Groom
- Academic Unit of Mental Health and Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK.
| | - Samuele Cortese
- Faculty of Environmental and Life Sciences, Center for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, Nottingham, UK
| |
Collapse
|
16
|
Grazioli S, Rosi E, Mauri M, Crippa A, Tizzoni F, Tarabelloni A, Villa FM, Chiapasco F, Reimers M, Gatti E, Bertella S, Molteni M, Nobile M. Patterns of Response to Methylphenidate Administration in Children with ADHD: A Personalized Medicine Approach through Clustering Analysis. CHILDREN 2021; 8:children8111008. [PMID: 34828721 PMCID: PMC8623097 DOI: 10.3390/children8111008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/05/2021] [Accepted: 10/27/2021] [Indexed: 11/19/2022]
Abstract
Individual responses to methylphenidate (MPH) can significantly differ in children with attention-deficit/hyperactivity disorder (ADHD) in terms of the extent of clinical amelioration, optimal dosage needed, possible side effects, and short- and long-term duration of the benefits. In the present repeated-measures observational study, we undertook a proof-of-concept study to determine whether clustering analysis could be useful to characterize different clusters of responses to MPH in children with ADHD. We recruited 33 children with ADHD who underwent a comprehensive clinical, cognitive, and neurophysiological assessment before and after one month of MPH treatment. Symptomatology changes were assessed by parents and clinicians. The neuropsychological measures used comprised pen-and-paper and computerized tasks. Functional near-infrared spectroscopy was used to measure cortical hemodynamic activation during an attentional task. We developed an unsupervised machine learning algorithm to characterize the possible clusters of responses to MPH in our multimodal data. A symptomatology improvement was observed for both clinical and neuropsychological measures. Our model identified distinct clusters of amelioration that were related to symptom severity and visual-attentional performances. The present findings provide preliminary evidence that clustering analysis can potentially be useful in identifying different responses to MPH in children with ADHD, highlighting the importance of a personalized medicine approach within the clinical framework.
Collapse
Affiliation(s)
- Silvia Grazioli
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy; (S.G.); (M.M.); (A.C.); (F.T.); (A.T.); (F.M.V.); (E.G.); (S.B.); (M.M.); (M.N.)
| | - Eleonora Rosi
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy; (S.G.); (M.M.); (A.C.); (F.T.); (A.T.); (F.M.V.); (E.G.); (S.B.); (M.M.); (M.N.)
- Correspondence:
| | - Maddalena Mauri
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy; (S.G.); (M.M.); (A.C.); (F.T.); (A.T.); (F.M.V.); (E.G.); (S.B.); (M.M.); (M.N.)
- PhD in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Alessandro Crippa
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy; (S.G.); (M.M.); (A.C.); (F.T.); (A.T.); (F.M.V.); (E.G.); (S.B.); (M.M.); (M.N.)
| | - Federica Tizzoni
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy; (S.G.); (M.M.); (A.C.); (F.T.); (A.T.); (F.M.V.); (E.G.); (S.B.); (M.M.); (M.N.)
| | - Arianna Tarabelloni
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy; (S.G.); (M.M.); (A.C.); (F.T.); (A.T.); (F.M.V.); (E.G.); (S.B.); (M.M.); (M.N.)
| | - Filippo Maria Villa
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy; (S.G.); (M.M.); (A.C.); (F.T.); (A.T.); (F.M.V.); (E.G.); (S.B.); (M.M.); (M.N.)
| | - Federica Chiapasco
- MD Course in Medicine and Surgery, Humanitas University, Via Manzoni 56, 20089 Milan, Italy; (F.C.); (M.R.)
| | - Maria Reimers
- MD Course in Medicine and Surgery, Humanitas University, Via Manzoni 56, 20089 Milan, Italy; (F.C.); (M.R.)
| | - Erika Gatti
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy; (S.G.); (M.M.); (A.C.); (F.T.); (A.T.); (F.M.V.); (E.G.); (S.B.); (M.M.); (M.N.)
| | - Silvana Bertella
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy; (S.G.); (M.M.); (A.C.); (F.T.); (A.T.); (F.M.V.); (E.G.); (S.B.); (M.M.); (M.N.)
| | - Massimo Molteni
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy; (S.G.); (M.M.); (A.C.); (F.T.); (A.T.); (F.M.V.); (E.G.); (S.B.); (M.M.); (M.N.)
| | - Maria Nobile
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy; (S.G.); (M.M.); (A.C.); (F.T.); (A.T.); (F.M.V.); (E.G.); (S.B.); (M.M.); (M.N.)
| |
Collapse
|
17
|
Jaeschke RR, Sujkowska E, Sowa-Kućma M. Methylphenidate for attention-deficit/hyperactivity disorder in adults: a narrative review. Psychopharmacology (Berl) 2021; 238:2667-2691. [PMID: 34436651 PMCID: PMC8455398 DOI: 10.1007/s00213-021-05946-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/31/2021] [Indexed: 12/12/2022]
Abstract
RATIONALE Psychostimulants, including methylphenidate (MPH), are the mainstay of pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) in adults. Even though MPH is the most commonly used medication for ADHD these days, there are relatively few resources available that provide comprehensive insight into the pharmacological and clinical features of the compound. OBJECTIVE The aim of this paper is to provide an up-to-date outline of the pharmacology and clinical utility of MPH for ADHD in adult patients. METHODS While conducting the narrative review, we applied structured search strategies covering the two major online databases (MEDLINE and Cochrane Central Register of Controlled Trials). In addition, we performed handsearching of reference lists of relevant papers. RESULTS Methylphenidate exhibits multimodal mechanism of action, working primarily as a dopamine and noradrenaline reuptake inhibitor. It also protects the dopaminergic system against the ongoing 'wearing off' (by securing a substantial reserve pool of the neurotransmitter, stored in the presynaptic vesicles). In placebo-controlled trials, MPH was shown to be moderately effective both against the core ADHD symptoms (standardized mean difference [SMD], 0.49; 95% confidence interval [CI], 0.35-0.64), and the accompanying emotion regulation deficits (SMD, 0.34; 95% CI, 0.23-0.45). The most common adverse events related to long-term treatment with MPH are decreased appetite (~ 20%), dry mouth (15%), heart palpitations (13%), gastrointestinal infections (~ 10%), and agitation/feeling restless (~ 10%). CONCLUSIONS There is substantial body of evidence to suggest that MPH is an effective and safe treatment option for adults with ADHD.
Collapse
Affiliation(s)
- Rafał R Jaeschke
- Section of Affective Disorders, Department of Psychiatry, Jagiellonian University Medical College, ul. Kopernika 21a, 31-501, Kraków, Poland.
| | - Ewelina Sujkowska
- Department of Human Physiology, Institute of Medical Sciences, Medical College of Rzeszów University, ul. Kopisto 2a, 35-315, Rzeszów, Poland
| | - Magdalena Sowa-Kućma
- Department of Human Physiology, Institute of Medical Sciences, Medical College of Rzeszów University, ul. Kopisto 2a, 35-315, Rzeszów, Poland
- Centre for Innovative Research in Medical and Natural Sciences, Medical College of Rzeszów University, ul. Warzywna 1a, 35-310, Rzeszów, Poland
| |
Collapse
|
18
|
A mixed herbal extract as an adjunctive therapy for attention deficit hyperactivity disorder: A randomized placebo-controlled trial. Integr Med Res 2021; 10:100714. [PMID: 33665099 PMCID: PMC7903061 DOI: 10.1016/j.imr.2021.100714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 12/24/2022] Open
Abstract
Background Methylphenidate improves clinical symptoms and brain activity in attention deficit hyperactivity disorder (ADHD) patients through the attention-regulation network's dopamine system. Additionally, water-soluble extracts (HX106) of four plants (Gastrodia elata Blume, Liriope platyphylla Wang et Tang, Salvia miltiorrhiza Bunge, and Dimocarpus longan Lour) improve cognitive function. We hypothesized that the combination of HX106 and methylphenidate would improve ADHD symptoms and brain activity of the attention network more effectively than the combination of placebo and methylphenidate. Methods Twenty-seven patients with ADHD were administered a herbal mixture and methylphenidate (n=13), or placebo and methylphenidate (n=14) during a 4-week, randomized, double-blind, placebo-controlled clinical trial. Changes in ADHD symptoms (K-ARS scores), as well as brain activity and functional connectivity, were assessed at baseline and 4 weeks later. Results The HX106 group showed a greater improvement in total attention (16.8%) and inattention (17.2%) scores than the placebo group. The HX106 group showed increased brain activity within the left precuneus compared to the placebo group. The HX106 group also showed increased functional connectivity from the precuneus seed to the left middle temporal gyrus compared with the placebo group. In all participants, the changes in K-ARS scores were negatively correlated with changes in brain activity in the left middle temporal gyrus. Conclusions HX106 enhanced the effect of methylphenidate on ADHD symptoms and increased brain activity in the attention-regulation network. Therefore, HX106 may be an effective adjunctive therapy for patients with ADHD.
Collapse
|
19
|
Childress AC. Novel Formulations of ADHD Medications: Stimulant Selection and Management. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:31-38. [PMID: 34483764 PMCID: PMC8412159 DOI: 10.1176/appi.focus.20200032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed psychiatric disorder in children and adolescents in the United States. In 2016, approximately 3.8 million U.S. children ages 2 to 17 years with ADHD were being treated with medication. There are approximately 30 different amphetamine (AMPH) and methylphenidate (MPH) formulations on the market. These include immediate-release and extended-release compounds. The extended-release formulations contain various ratios of immediate-release and extended-release components, which determine the pharmacokinetic (PK) profile. For stimulants, the PK and pharmacodynamic (PD) profiles are tightly linked, and the immediate-release and extended-release percentages influence onset and duration of drug effects. Choosing the right stimulant medication for a patient depends on an understanding of the PK/PD profile, the time of day that symptoms are most impairing, the need for morning and evening symptom control and individual patient preferences.
Collapse
Affiliation(s)
- Ann C Childress
- Center for Psychiatry and Behavioral Medicine, Inc., Las Vegas
| |
Collapse
|
20
|
Childress AC, Uchida CL, Po MD, DeSousa NJ, Incledon B. A Post Hoc Comparison of Prior ADHD Medication Dose and Optimized Delayed-release and Extended-release Methylphenidate Dose in a Pivotal Phase III Trial. Clin Ther 2020; 42:2332-2340. [PMID: 33168234 DOI: 10.1016/j.clinthera.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE HLD200 is the first evening-dosed, delayed-release and extended-release methylphenidate (DR/ER-MPH) designed to delay initial release of MPH and provide treatment effects throughout the day and into the evening for individuals with attention-deficit/hyperactivity disorder (ADHD). Because DR/ER-MPH is uniquely absorbed in the colon, it cannot be substituted for other ADHD medications on a milligram-per-milligram basis. To provide clinicians with a target dose range for DR/ER-MPH when transitioning patients from a prior ADHD medication, dose conversion ratios (DCRs) between prior medication doses and optimized doses of DR/ER-MPH were determined post hoc from a pivotal Phase III study of children (aged 6-12 years) with ADHD. METHODS DR/ER-MPH doses were optimized over a 6-week open-label period. DCRs were calculated between optimized doses of DR/ER-MPH at week 6 and prior stable doses of ADHD medication. FINDINGS Mean DCRs ranged from 1.8 to 4.3 for optimized DR/ER-MPH dose versus previous stable dose for individuals taking an extended-release stimulant monotherapy. DCRs for those taking an immediate-release stimulant monotherapy ranged from 4.7 to 6.0. IMPLICATIONS In a Phase III trial of children with ADHD, optimized doses of DR/ER-MPH were higher than doses of prior ADHD medications, but the adverse event profile was consistent with that of other MPHs. Higher DCRs compared with those predicted by bioavailability differences are consistent with a predicted dose-dependent duration of effect for DR/ER-MPH: with increasing doses, absorption is extended but with an attenuated increase in Cmax compared with MPH formulations absorbed in the upper bowel. These data may help guide clinicians to optimize DR/ER-MPH doses. ClinicalTrials.gov identifier: NCT02493777.
Collapse
Affiliation(s)
- Ann C Childress
- Center for Psychiatry and Behavioral Medicine, Inc, Las Vegas, NV, USA.
| | | | | | - Norberto J DeSousa
- Ironshore Pharmaceuticals & Development, Inc, Camana Bay, Grand Cayman, Cayman Islands
| | - Bev Incledon
- Ironshore Pharmaceuticals & Development, Inc, Camana Bay, Grand Cayman, Cayman Islands
| |
Collapse
|
21
|
Adjei AL, Chaudhary I, Kollins SH, Padilla A. A Pharmacokinetic Study of Methylphenidate Hydrochloride Multilayer Extended-Release Capsules (Aptensio XR ®) in Preschool-Aged Children with Attention-Deficit/Hyperactivity Disorder. Paediatr Drugs 2020; 22:561-570. [PMID: 32776159 PMCID: PMC7529626 DOI: 10.1007/s40272-020-00409-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This was a single-dose, one-period, multicenter, pharmacokinetic (PK) study to evaluate the PK of methylphenidate (MPH) hydrochloride multilayer extended-release capsules (MPH-MLR) in preschool children aged 4 to < 6 years, previously diagnosed with attention-deficit/hyperactivity disorder (ADHD), and on a stable dose of MPH. METHODS Preschool-aged children (N = 10) received a single oral dose of MPH-MLR (10, 15, or 20 mg) sprinkled over applesauce; a dose equivalent to their pre-enrollment daily dose of MPH. Blood samples for the measurement of MPH concentrations were obtained pre-dose and at 0.5, 1, 2, 3, 4, 6, 8, 10, 12, and 24 h post-dose. No structural model was assumed in the derivation of PK values for analysis. Maximum plasma concentration (Cmax), area under the concentration-time curve (AUC), elimination half-life, clearance (CL), and volume of distribution (Vd) data were compared with a historical group of older children aged 6-11 years (N = 11) and analyzed by bodyweight. Safety (adverse event monitoring, vital signs, electrocardiogram, clinical laboratory testing, physical examination) was assessed. RESULTS Mean dose-normalized Cmax and area under the curve to the last measurable observation (AUC0-t) values were similar across dose groups, ranging from 0.67 ng/mL/mg (MPH 15 mg) to 0.81 ng/mL/mg (MPH 10 mg) for Cmax/dose, and from 7.80 h × ng/mL/mg (MPH 20 mg) to 8.92 h × ng/mL/mg (MPH 10 mg) for AUC0-t/dose. PK results were integrated into a previously described pharmacostatistical population PK model. Visual predictive check plots showed greater variability in the 6- to 11-year-old group than the 4- to < 6-year-old group, and CL increased with increasing body weight in a greater than dose-proportional manner. Mean CL, normalized for body weight, was constant for all dose groups, ranging from 4.88 L/h/kg to 5.80 L/h/kg. Median time to Cmax ranged from 2.00 to 3.00 h post-dose, and overall, dose-normalized Cmax concentrations indicated greater systemic exposures of MPH-MLR in preschool children aged 4 to < 6 years compared with children aged 6-11 years. Children aged 4 to < 6 years had a lower Vd than children aged 6-11 years. There were no unexpected safety signals. CONCLUSION The PK of MPH-MLR in preschool children demonstrated the biphasic absorption profile described earlier in older children, and the PK profile in children with ADHD aged 4 to < 6 years was similar to the profile in those aged 6-11 years, apart from a lower Vd and relatively higher systemic MPH levels for children in the preschool group. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT02470234.
Collapse
Affiliation(s)
- Akwete L. Adjei
- Rhodes Pharmaceuticals L.P., 498 Washington St., Coventry, RI 02816 USA
| | - Inder Chaudhary
- Rhodes Pharmaceuticals L.P., 498 Washington St., Coventry, RI 02816 USA
| | - Scott H. Kollins
- grid.26009.3d0000 0004 1936 7961Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC USA
| | - Americo Padilla
- grid.415486.a0000 0000 9682 6720Department of Pediatric Psychiatry, Nicklaus Children’s Hospital, Miami, FL USA
| |
Collapse
|