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

Abstract

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 multisite 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 ADHDinattentive 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).

Remission in Children and Adolescents Diagnosed with Attention-Deficit/Hyperactivity Disorder via an Effective and Tolerable Titration Scheme for Osmotic Release Oral System Methylphenidate

“…Similar to the results in Western countries, the efficacy and safety of IR-MPH and OROS-MPH have been established in two clinical trials conducted in ethnic Chinese ADHD populations (Yang et al 2004;Gau et al 2006). In addition, after switching to OROS-MPH from IR-MPH, the improvement in remission rates of ADHD, behaviors, and school performance through improving patients' drug adherence have been demonstrated in two multisite studies conducted among Chinese ADHD populations in Taiwan (Gau et al, 2008a;Chou et al, 2009).…”

“…Our study showed that at the baseline, the mean IR-MPH daily dose after at least 1 month of treatment was only 21.4 mg (0.61 mg/kg) and the remission rate at the baseline prior to the switch to OROS-MPH was only 4.9%. This finding suggests that even with the use of rating scales, child psychiatrists tend to use relatively low doses of drugs, such as IR-MPH twice a day, because of their concern about side effects and the patient's intolerance of medications, even though the patients still exhibit symptoms (Chou et al 2009). Therefore, we can see that the clinical practice in Taiwan is relatively conservative, in which drugs given to ADHD children and adolescents are initially prescribed at a low level and are slowly titrated.…”

“…Failure to achieve remission is associated with a significant impact on the patient's psychosocial functioning, and an increase in the risk of relapse and a chronic course (Satterfield and Schell 1997;Biederman et al 1998). Management of ADHD should consider those medication strategies that have been demonstrated to increase the probability of reaching remission (Steele et al 2006b;Gau et al 2008a;Chou et al 2009). Methylphenidate is the best-studied stimulant for ADHD, and a number of studies demonstrate that the remission rates range from 21-56% in ADHD patients treated with immediate-release methylphenidate (IR-MPH) (Greenhill et al 2006;Swanson et al 2001), to 44-62% in ADHD children and adolescents treated with osmotic release oral system methylphenidate (OROS-MPH) (Swan 1995;Swanson et al 2004;Steele et al 2006b;Gau et al 2008a).…”

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

“…The 26 items of the SNAP-IV are rated on a four point Likert scale, with scores of 0-3 representing ''not at all,'' ''just a little,'' ''quite a bit,'' and ''very much,'' respectively. The Chinese SNAP-IV-Parent (Gau et al 2008) and -Teacher ) Forms have good validity and reliability, and have been widely used in clinical trials to assess the efficacy of OROS-methylphenidate (Chou et al 2009) and atomoxetine (Gau and Shang 2010) in children with ADHD.…”

Improving Medication Adherence in Chronic Pediatric Health Conditions: A Focus on ADHD in Youth

“…Note that the above studies were mostly conducted with immediate release stimulants; an important but less well-studied factor is whether adherence varies as a function of the formulation used (i.e., immediate-release or extendedrelease). This evolving literature suggests that adherence is somewhat improved with extended-release versus immediate-release forms of medication [22,27,32], although extended-release forms of stimulant medication do not always result in greater adherence over extended periods of time [33].…”