Better efficacy for the osmotic release oral system methylphenidate among poor adherents to immediate‐release methylphenidate in the three ADHD subtypes

Apr 2, 2009Psychiatry and clinical neurosciences

Better results with extended-release methylphenidate for poor responders to immediate-release in all three types of ADHD

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Abstract

Out of 240 children with ADHD, 137 switched to osmotic release oral system methylphenidate (OROS-MPH).

Higher dosages, shorter treatment duration, and thrice-daily administration of immediate-release methylphenidate (IR-MPH) were associated with switching to OROS-MPH.
More severe inattention symptoms were linked to the decision to switch medications.
Children with the ADHD-combined and hyperactive-impulsive subtypes exhibited greater hyperactivity and oppositional symptoms compared to those with the inattentive subtype.
Significant improvements in behavioral symptoms and family/school dynamics were observed after switching to OROS-MPH, particularly in the ADHD-combined group.
Inattention negatively impacted academic performance and classroom behaviors, with parent-child relationships also affected by oppositional symptoms.

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AIMS: To determine factors for switching to osmotic release oral system methylphenidate (OROS-MPH) among poor adherents to immediate-release methylphenidate (IR-MPH); and to compare the efficacy of OROS-MPH on the three attention-deficit/hyperactivity disorder (ADHD) subtypes in a multi-site prospective observational study in Taiwan.

METHODS: The sample included 240 children with ADHD, aged 6-16 years, who were poor adherents to IR-MPH, 137 of whom were switched to OROS-MPH. The child psychiatrists diagnosed the Diagnostic Statistical Manual of Mental Disorders (4th edition) ADHD subtypes and assessed the medical history, adherence, side-effects, global ADHD severity, and family/school effectiveness. Parents reported their child's behavioral symptoms.

RESULTS: The determinants for an OROS-MPH switch were higher dosage, shorter treatment and thrice-daily administration of IR-MPH, and more severe inattention symptoms. Hyperactivity and oppositional symptoms were greater in the ADHD combined and hyperactive-impulsive subtypes than the inattentive subtype. Switching to OROS-MPH significantly improved behavioral symptoms and family/school measures, and this was most evident in the ADHD-combined group, followed by the ADHD-inattentive group. Inattention influenced not only academic performance, but also overall classroom behaviors and the parent-child relationship, with the latter two also influenced by oppositional symptoms.

CONCLUSIONS: This study suggests better efficacy for the OROS-MPH among poor adherents to IR-MPH; however, its effectiveness varied across the three ADHD subtypes (ClinicalTrials.gov number NCT00460720).

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Better efficacy for the osmotic release oral system methylphenidate among poor adherents to immediate‐release methylphenidate in the three ADHD subtypes

Abstract

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