Efficacy and safety of atomoxetine as add-on to psychoeducation in the treatment of attention deficit/hyperactivity disorder

Abstract

International audienc

Systematic review of atomoxetine data in childhood and adolescent attention-deficit hyperactivity disorder 2009–2011: Focus on clinical efficacy and safety

“…In the 12-week study (n=151), the effect size at 6 weeks (0.55) increased in a linear direction to 0.82 at 12 weeks with no suggestion of a plateau, while maximal placebo response was reached at 6 weeks (Montoya et al, 2009). Similar results were seen using change in ADHD-RS in the 10-week study, giving a final effect size of 1.3, with 63% of patients having a response of >40% (Svanborg et al, 2009), although this study was not powered to measure the effect size using ADHD-RS. In the 6-week study there appeared to be a linear reduction with no suggestion of plateau at 6 weeks (Martényi et al, 2010).…”

“…The 10-12 week treatment-naïve studies also found larger effect sizes for ATX (0.8-1.3) than generally accepted, and emphasise the clinical value of using treatment-naïve populations as a baseline comparator in ADHD (Montoya et al, 2009;Svanborg et al, 2009). In the Newcorn 2008 comparative 6-week study, although efficacy was significantly greater in the OROS-MPH cohort than ATX, this greater efficacy was not found in the treatment-naïve cohort where effect sizes were similar (0.9-1) (Newcorn et al, 2008).…”

“…A critical finding in the treatment-naïve studies (Martényi et al, 2010;Montoya et al, 2009;Svanborg et al, 2009) was that effect size of ATX was greatest at study completion (6, 10, and 12 weeks, respectively), and in the Montoya study showed no sign of plateau even at 12 weeks (Montoya et al, 2009). The effect size at 6 weeks of 0.55 had increased in almost linear manner to 0.82 at 12 weeks (Montoya et al, 2009).…”

“…Onset of response is reported in five placebo studies predominantly measured by the Attention-deficit Hyperactivity Disorder Rating Scale (Table 1). In a 6-week RCT of treatment-naïve patients, the ATX cohort was significantly improved at 4 weeks (p=0.042) (at 2 weeks p=0.054) (Martényi et al, 2010) and treatment-naïve studies of longer durations (10 and 12 weeks) reported onset of response at Week 3 (p<0.001) and Week 4 (p=0.003), respectively (Montoya et al, 2009;Svanborg et al, 2009). In non-treatment-naïve trials a 6-week study comparing morning and evening dosing with placebo reported significant improvement in ADHD-RS at 1 week in both dosing arms (Block et al, 2009), and an 8-week study reported improvement at week 2 but only in the 1.8 mg/kg cohort (Takahashi et al, 2009 In a post hoc analysis of two open-label studies (n=421) over 24 weeks using the Weekly Rating of Evening and Morning Behaviour (WREMB-R) and Global Impression of Perceived Difficulties (GIPD) scales, significant improvement was measured predominantly over the initial 2 weeks with maintenance over 24 weeks .…”

Child and Caregiver Issues In the Treatment of Attention Deficit–Hyperactivity Disorder: Education, Adherence and Treatment Choice

“…An excellent example of what is considered to be a structured psychoeducation program for mental health has been developed by Colom and Vieta [40]; this program has shown efficacy in reducing core symptoms and the frequency of relapse while improving treatment adherence. Although no meta-analysis regarding the efficacy of these interventions in ADHD has been carried out [41] (the literature regarding this specific topic is particularly scarce in ADHD), some studies have demonstrated the potential of these programs to reduce symptoms, improve quality of life and improve parents' knowledge and treatment adherence [8,9,[41][42][43]. These types of interventions are probably underutilized in ADHD and in psychiatry generally.…”