An Open-Label, Randomized Trial of Methylphenidate and Atomoxetine Treatment in Children with Attention-Deficit/Hyperactivity Disorder

Shang, Chi-Yung; Pan, Yi-Lei; Lin, Hon‐Yi; Huang, Lin-Wan; Gau, Susan Shur‐Fen

doi:10.1089/cap.2015.0035

Cited by 28 publications

(29 citation statements)

References 39 publications

(46 reference statements)

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“…Figure 7 shows the results of the five studies that compared the number of adverse cardiac events between children and adolescents receiving methylphenidate and atomoxetine treatment [13,49,50,51,52]. There was no difference in the number of adverse cardiac events between the participants treated with methylphenidate and atomoxetine (OR = 0.88, 95% CI: 0.51–1.51, z = −0.47, p = 0.64).…”

Section: Resultsmentioning

confidence: 99%

The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression

Liang

Lim

Tam

et al. 2018

IJERPH

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Objectives: This meta-analysis aims to study the effects of atomoxetine and methylphenidate on heart rate (HR), systolic blood pressure (SBP), and a number of adverse cardiac events on patients receiving treatment for attention-deficit hyperactive disorder (ADHD) in comparison to placebo and between atomoxetine and methylphenidate. Methods: We searched the following databases: PubMed, EMBASE, and ScienceDirect. Meta-analysis was performed on studies that examined the relationships between methylphenidate or atomoxetine and HR, SBP, as well as a number of adverse cardiac events. These studies were either placebo-controlled or comparison studies between methylphenidate and atomoxetine. Meta-regression identified patient- and treatment-related factors that may contribute to heterogeneity. Results: Twenty-two studies were included and the total number of participants was 46,107. Children/adolescents and adults treated with methylphenidate had more significant increases in post- vs. pre-treatment HR (p < 0.001) and SBP (p < 0.001) than those treated by placebo. Children and adolescents treated with atomoxetine had more significant increases post- vs. pre-treatment HR (p = 0.025) and SBP (p < 0.001) than those treated with methylphenidate. Meta-regression revealed mean age of participants, mean dose, and duration of atomoxetine and methylphenidate as significant moderators that explained heterogeneity. There were no differences in the number of adverse cardiac events between participants with methylphenidate treatment and placebo or atomoxetine. Conclusions: Children/adolescents and adults treated with methylphenidate resulted in significant increases in post- vs. pre-treatment HR and SBP as compared to placebo. Similarly, children and adolescents treated with atomoxetine had significant increases in post- vs. pre-treatment HR and SBP than those treated with methylphenidate. These findings have potential implications for continuous monitoring of HR and SBP throughout the course of treatment although the risk for adverse cardiac events were insignificant.

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Section: Resultsmentioning

confidence: 99%

The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression

Liang

Lim

Tam

et al. 2018

IJERPH

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“…Clonidine immediate release and guanfacine immediate release could not be included in the network due to lack of data. Trials: Biederman [ 28 ]; Biederman [ 29 ]; Block [ 32 ]; Coghill [ 33 ]; Dittmann [ 34 ]; Dittmann [ 35 ]; Findling [ 36 ]; Findling [ 37 ]; Garg [ 38 ]; Gau [ 39 ]; Hervas [ 41 ]; Kelsey [ 42 ]; Kollins [ 43 ]; López [ 44 ]; Martenyi [ 45 ]; Montoya [ 48 ]; Newcorn [ 49 ]; Newcorn [ 50 ]; Palumbo [ 51 ]; Sallee [ 30 ]; Shang [ 52 ]; Spencer [ 31 ]; Steele [ 53 ]; Su [ 54 ]; Takahashi [ 55 ]; Wang [ 56 ]; Wehmeier [ 57 ]; Weiss [ 58 ]; Wigal [ 59 ]; Wilens [ 60 ]; Wilens [ 61 ]; Wolraich [ 62 ]. ATX atomoxetine; GXR guanfacine extended release, LDX lisdexamfetamine dimesylate, MPH-ER/OROS methylphenidate extended release/osmotic-release oral system, MPH-IR methylphenidate immediate release …”

Section: Resultsmentioning

confidence: 99%

“…Quality assessment criteria were examined for all included studies (Table 3 ). All of the studies were blinded, except for Kemner et al [ 22 ], Steele et al [ 53 ], Gau et al [ 39 ], Garg et al [ 38 ], Shang et al [ 52 ], and Su et al [ 54 ], which were open-label studies. The method of ADHD-RS-IV rating was generally consistent across trials.…”

Section: Resultsmentioning

confidence: 99%

Comparative efficacy and safety of attention-deficit/hyperactivity disorder pharmacotherapies, including guanfacine extended release: a mixed treatment comparison

Joseph¹,

Ayyagari

Xie

et al. 2017

Eur Child Adolesc Psychiatry

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This study compared the clinical efficacy and safety of attention-deficit/hyperactivity disorder (ADHD) pharmacotherapy in children and adolescents 6–17 years of age. A systematic literature review was conducted to identify randomized controlled trials (RCTs) of pharmacologic monotherapies among children and adolescents with ADHD. A Bayesian network meta-analysis was conducted to compare change in symptoms using the ADHD Rating Scale Version IV (ADHD-RS-IV), Clinical Global Impression–Improvement (CGI-I) response, all-cause discontinuation, and adverse event-related discontinuation. Thirty-six RCTs were included in the analysis. The mean (95% credible interval [CrI]) ADHD-RS-IV total score change from baseline (active minus placebo) was −14.98 (−17.14, −12.80) for lisdexamfetamine dimesylate (LDX), −9.33 (−11.63, −7.04) for methylphenidate (MPH) extended release, −8.68 (−10.63, −6.72) for guanfacine extended release (GXR), and −6.88 (−8.22, −5.49) for atomoxetine (ATX); data were unavailable for MPH immediate release. The relative risk (95% CrI) for CGI-I response (active versus placebo) was 2.56 (2.21, 2.91) for LDX, 2.13 (1.70, 2.54) for MPH extended release, 1.94 (1.59, 2.29) for GXR, 1.77 (1.31, 2.26) for ATX, and 1.62 (1.05, 2.17) for MPH immediate release. Among non-stimulant pharmacotherapies, GXR was more effective than ATX when comparing ADHD-RS-IV total score change (with a posterior probability of 93.91%) and CGI-I response (posterior probability 76.13%). This study found that LDX had greater efficacy than GXR, ATX, and MPH in the treatment of children and adolescents with ADHD. GXR had a high posterior probability of being more efficacious than ATX, although their CrIs overlapped.Electronic supplementary materialThe online version of this article (doi:10.1007/s00787-017-0962-6) contains supplementary material, which is available to authorized users.

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“…The CGI‐ADHD‐S was used for the assessments of the pre‐treatment and post‐treatment with an 8‐week interval. This scale has been widely used in the treatment studies on ADHD in Taiwan [Gau et al, , ; Gau and Shang, , ; Shang et al, ].…”

Section: Methodsmentioning

confidence: 99%

Neural correlates of atomoxetine improving inhibitory control and visual processing in Drug‐naïve adults with attention‐deficit/hyperactivity disorder

Fan

Chou

Gau

2017

Human Brain Mapping

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Atomoxetine improves inhibitory control and visual processing in healthy volunteers and adults with attention-deficit/hyperactivity disorder (ADHD). However, little is known about the neural correlates of these two functions after chronic treatment with atomoxetine. This study aimed to use the counting Stroop task with functional magnetic resonance imaging (fMRI) and the Cambridge Neuropsychological Test Automated Battery (CANTAB) to investigate the changes related to inhibitory control and visual processing in adults with ADHD. This study is an 8-week, placebo-controlled, double-blind, randomized clinical trial of atomoxetine in 24 drug-naïve adults with ADHD. We investigated the changes of treatment with atomoxetine compared to placebo-treated counterparts using the counting Stroop fMRI and two CANTAB tests: rapid visual information processing (RVP) for inhibitory control and delayed matching to sample (DMS) for visual processing. Atomoxetine decreased activations in the right inferior frontal gyrus and anterior cingulate cortex, which were correlated with the improvement in inhibitory control assessed by the RVP. Also, atomoxetine increased activation in the left precuneus, which was correlated with the improvement in the mean latency of correct responses assessed by the DMS. Moreover, anterior cingulate activation in the pre-treatment was able to predict the improvements of clinical symptoms. Treatment with atomoxetine may improve inhibitory control to suppress interference and may enhance the visual processing to process numbers. In addition, the anterior cingulate cortex might play an important role as a biological marker for the treatment effectiveness of atomoxetine. Hum Brain Mapp 38:4850-4864, 2017. © 2017 Wiley Periodicals, Inc.

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An Open-Label, Randomized Trial of Methylphenidate and Atomoxetine Treatment in Children with Attention-Deficit/Hyperactivity Disorder

Abstract: After 24 weeks of treatment, OROS-methylphenidate and atomoxetine had comparable efficacy in reducing core ADHD symptoms in drug-naïve children and adolescents with ADHD.

Cited by 28 publications

References 39 publications

The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression

The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression

Comparative efficacy and safety of attention-deficit/hyperactivity disorder pharmacotherapies, including guanfacine extended release: a mixed treatment comparison

Neural correlates of atomoxetine improving inhibitory control and visual processing in Drug‐naïve adults with attention‐deficit/hyperactivity disorder

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