Optimizing outcomes in ADHD treatment: from clinical targets to novel delivery systems

Abstract

Our knowledge and understanding of the underlying neurobiology and symptomatic expression of ADHD has advanced dramatically over the past decade. Associated with these advances has been a similar explosion of new treatment options to individualize treatment for our patients. This article will: ∙ review strategies to measure ADHD symptoms and functional difficulties while seeking to achieve full symptomatic remission throughout the day ∙ summarize recent findings regarding the management and prioritization of ADHD and comorbid conditions and ∙ discuss the various pharmacologic treatment options with a focus on recently developed molecules and novel delivery systems.

A Phase 3, Placebo-Controlled Trial of Once-Daily Viloxazine Extended-Release Capsules in Adolescents With Attention-Deficit/Hyperactivity Disorder

“…44 Historically, clinical trials have defined the efficacy threshold for ADHD-RS symptomatic improvement as 25% to 30%; evidence exists, however, that such improvement often leaves individuals with significant symptomatic and functional impairment. 45 , 46 Hence, a clinical response that integrates both a ≥50% reduction in symptoms and a second measure of clinical improvement (eg, CGI-I of 1 [very much improved] or 2 [much improved]) was suggested as a more meaningful clinical measure of treatment effectiveness. 16 Specifically, previous analyses of the relationship between ADHD-RS-5 and CGI-I scores demonstrated that a considerable symptomatic improvement of 50% to 60% on the ADHD-RS scale is needed to achieve a “much improved” rating on the CGI-I.…”

A clinician’s guide for navigating the world of attention deficit hyperactivity disorder medications

“…27 Studies with all three classes of medications, methylphenidates, amphetamines, and non-stimulants, have highlighted that it is all too easy for clinicians to settle for partial improvement while still leaving patients with ongoing symptomatology. 28 Clinical response has often been defined as a 25% to 30% symptom improvement, but this still leaves patients with ongoing significant symptomatic and functional impairment. Interestingly, clinicians interpret 30% symptom improvement as "much" or even "very much improved" on global clinical measures.…”

“…33,34 Most individuals with ADHD will have moderate to moderately severe symptoms when first presenting for diagnosis or treatment with corresponding ADHD-RS scores in the 30 seconds to low 40 seconds (18 symptoms rated 0 to 3, 0 none, 1 mild, 2 moderate, and 3 severe). 28 A recent study with MPH DR/ER dosed in the evening for ADHD children demonstrated that ADHD symptoms could be decreased from 42 to 11 after 6 weeks of dose titration, with an average final dose of 60 mg per day. To put this in clinical perspective; these children were highly symptomatic with ADHD scores that were moderate or severe on all 18 items and by the end of 6 weeks their ADHD symptoms were mild or none on average.…”

Adult Patient Preferences for Long-Acting ADHD Treatments: A Discrete Choice Experiment

“…According to a review article, health-care providers tend to be most concerned with symptom control during work or school hours for patients with ADHD; as such, they may not take into consideration that symptom control at the beginning and end of the day may be very important to patients and caregivers. 66 Patients desiring a quick onset and longer duration of effect (14-16 hours) were most likely to have stressful or burdensome work activities and have children at home, suggesting they desired quick onset and longer duration medications to meet the demands they face in the morning, during work hours and after. Conversely, patients desiring to minimize side effects were least likely to be employed, have a college degree, and to take their medication daily.…”