Comparative efficacy of methylphenidate and atomoxetine in oppositional defiant disorder comorbid with attention deficit hyperactivity disorder

Abstract

Background:Oppositional defiant disorder (ODD) is frequently comorbid with attention deficit hyperactivity disorder (ADHD) and is associated with substantial functional impairments. Methylphenidate and atomoxetine are well-established drugs for the management of ADHD. Some studies from Western countries have reported these drugs to be effective in the management of ODD comorbid with ADHD. This study aimed to assess if methylphenidate and atomoxetine are efficacious in treating Indian children with ODD comorbid with ADHD.Subjects and Methods:In this prospective, open-label study, 37 patients of age 6–14 years with a diagnosis of ODD comorbid with ADHD randomly received either methylphenidate (dose 0.2–1 mg/kg/day) or atomoxetine (dose 0.5–1.2 mg/kg/day) for 8 weeks. Improvements in ADHD and ODD symptoms were assessed using Vanderbilt ADHD diagnostic parent rating scale (VADPRS).Results:At 8 weeks, there were statistically significant improvements in both ADHD and ODD symptoms in both methylphenidate and atomoxetine groups, as per VADPRS. The improvements produced and tolerability was comparable in the two groups. 80% of the patients from methylphenidate group and 64.3% patients from atomoxetine group ceased to fulfill the criteria for the presence of ODD at 8 weeks.Conclusions:Methylphenidate and atomoxetine are effective in the treatment of ODD comorbid with ADHD in short duration.

A Randomized, Double-Blind, Placebo-Controlled, Two-Way Crossover Clinical Trial of ORADUR-Methylphenidate for Treating Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

“…Surprisingly, although MPH in this study has been demonstrated to bring about improvements in ODD symptoms as reported by the parents and teachers in the study, the effects of MPH on ODD symptoms were not significantly different to those of the placebo. Several clinical trials (Garg et al 2015;Masi et al 2017;Golubchik et al 2018;Pan et al 2018;Sultan et al 2019), including ours (Shang et al 2015;Shih et al 2019), have reported that MPH is able to reduce ODD symptoms. Nevertheless, there is a significant amount of evidence available, supporting the idea that ADHD patients with ODD symptoms or an ODD diagnosis seem to benefit from the addition of atypical antipsychotics, such as risperidone (Masi et al 2017;Sultan et al 2019), quetiapine (Sultan et al 2019), and aripiprazole (Pan et al 2018;Sultan et al 2019), to their MPH treatment (Masi et al 2017;Golubchik et al 2018); these additional useful interventions also include psychosocial interventions (Abikoff et al 2004;Van der Oord et al 2008;Chan et al 2016;Suzer Gamli and Tahiroglu 2018).…”

“…Our randomization procedure should have also diminished any period effect (Richens et al 2001;Li et al 2015). Fifth, although the efficacy of ORADUR-MPH has been demonstrated in this study and the tolerability was good, this study does not provide information about a head-to-head comparison of ORADUR-MPH with other formulations of MPH (Gau et al 2006b;Coghill et al 2013) or with atomoxetine (Garg et al 2015;Ni et al 2016Ni et al , 2017Shang et al 2016), both of which are currently used for treating ADHD. Finally, like all the MPH treatment studies, methylphenidate gives rise to several easily recognizable AEs, one such being decreased appetite; such well-known adverse effects may lead to a loss of blinding and thus influence rating of symptom, particularly when this is carried out by parents and assessors who have knowledge of reported adverse effects.…”

“…efficacy of the various MPH formulations available (Coghill et al 2013) and to carry out a comparative study against atomoxetine (Garg et al 2015;Ni et al 2016Ni et al , 2017Shang et al 2016).…”

“…It will be very useful in the future if the efficacy of ORADUR-MPH on other emotional and behavioral problems (Shih et al 2019 ), social functionality (Shang et al 2019 ), neuropsychological performance (Ni et al 2013), and brain functioning (Chou et al 2015 ) is investigated. It would also be very helpful to conduct head-to-head studies to obtain data on the comparative efficacy of the various MPH formulations available (Coghill et al 2013 ) and to carry out a comparative study against atomoxetine (Garg et al 2015 ; Ni et al 2016 , 2017; Shang et al 2016 ).…”

A strategy for increasing the efficiency of psychopharmacological treatment of hyperkinetic behavior disorder with pantogam

“…В ряде публикаций показана возможность экстраполяции применительно к ГРП современных терапевтических подходов для лечения СДВГ, преимущественно касающихся назначения психостимуляторов и атомоксетина. При этом указывается на бо`льшие трудности курации данной категории детей по сравнению с более «чистыми» вариантами гиперкинетических нарушений [10][11][12], необходимость применения более высоких доз лекарственных препаратов [13] и зависимость степени редукции поведенческих симптомов от выраженности общей реакции на терапию симптоматики СДВГ [14].…”