Latino Versus Caucasian Response to Atomoxetine in Attention-Deficit/Hyperactivity Disorder

Abstract

We examined the effects of atomoxetine in Latino (n = 108) versus Caucasian (n = 1090) pediatric outpatients (aged 6 to <18 years) during the first 10-11 weeks of treatment in two multicenter, open-label trials. Mean modal doses were not significantly different in Latinos (1.22 mg/kg per day) versus Caucasians (1.27 mg/kg per day; p = 0.22). Both groups showed significant and similar improvements: Mean ADHD Rating Scale-IV-Parent Version: Investigator Administered and Scored (ADHDRS-IV-P:I) scores decreased by 54% in Latinos (40.9-18.9; p < 0.001) and by 52% in Caucasians (37.7-18.2; p < 0.001). Other efficacy measures, such as Conners' Parent Rating Scale-Revised: Short Form (CPRS-R:S) and Clinical Global Impressions-ADHD-Severity (CGI-ADHD-S), demonstrated similar and significant decreases. The only significant between-group difference was a greater decrease in the ADHDRS-IV-P:I Hyperactive/Impulsive subscale at weeks 8-11 for Latinos; however, Latinos had higher baseline scores compared with Caucasians. This was not demonstrated in the CPRS-R:S Hyperactivity subscale. There was a significantly higher frequency of CYP2D6 slow metabolizers in Caucasians compared with Latinos. Caucasians reported significantly more abdominal and throat pain, whereas Latinos reported more decreased appetite and dizziness, but no differences in other common adverse events were reported. No suicidal behavior was reported in either group. We found that Latino and Caucasian children with attention-deficit/hyperactivity disorder (ADHD) exhibit a similar pattern of efficacy and tolerability with atomoxetine. The lack of placebo controls was a limitation of this study.

Use of Treatment Services for Attention-Deficit/Hyperactivity Disorder in Latino Children

“…With regard to medication use, recent data indicate that Latino children use medication for ADHD at less than half the rate of Caucasian children in the United States [32], despite beneficial outcomes associated with medication use [10, 12]. These data are consistent with international data demonstrating similar disparities in medication use for ADHD among children across several Latin American countries [6, 33].…”

“…Data from a recent study contribute to existing research suggesting that Latino children benefit from medication when they use it [10]. A large, open-label, multicenter trial of atomoxetine, a commonly prescribed alternative to stimulant medication for ADHD, was recently conducted among Latino ( n =108) and Caucasian ( n =1090) children.…”

The Safety of Atomoxetine for the Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Comprehensive Review of Over a Decade of Research

“…In our predefined literature search, we identified 13 studies and two case reports related to suicidality or self-harm [17,18,[25][26][27][28][29][30][31][32][33][34][35][36][37]. The nine studies with the largest atomoxetine-treated patient populations (range 421-6818) were four meta-analyses and one pooled analysis of data from atomoxetine pediatric clinical trials, two national register-based studies, and two clinical trials [17, 25-27, 29, 30, 32, 33, 36].…”

The occurrence of adverse drug reactions reported for attention deficit hyperactivity disorder (ADHD) medications in the pediatric population: a qualitative review of empirical studies

“…Information about ADRs was reported in clinical studies using different designs, ie, randomized parallel group studies (N = 28);12–15,17–19,22,23,28,31,32,34–36,40,42–47,48–54 randomized crossover studies (N = 6);16,23,25,27,30,39 and open-label designs (N = 9) 20,26,29,33,37,38,41,50. The majority of studies were conducted in naturalistic settings at home and at school (N = 38);12,13,15–22,24,26,28–30,31–43,44–54 five articles reported ADRs from children participating in laboratory school protocols,14,23,25,27,30 in which classroom sessions were organized in cycles to include 12 hours of observation.…”

“…Parents rated information about ADRs in 20 studies,12–15,19,25–28, 32,35–36,40–46,48,50,52 54 patients in 15 studies,18,20–24,31,33–35,38–39,42,44,47 and a combination of teacher/parent (five studies),16–17,30,48–49 and patient/parent (three studies) 27,49,51. The articles specified only limited information about applied ADR scales and the classification systems used.…”