Umstellung von einem unretardierten auf ein retardiertes Methylphenidatpräparat: Eine multizentrische, offene Studie an Kindern mit ADHS

Abstract

Changing patients' medication from IR-MPH to a single daily dose of OROS-MPH resulted in a significant improvement of ADHD symptoms as rated by parents. In a school setting, the efficacy of OROS-MPH was comparable to that of IR-MPH.

Editorial: Observational studies in ADHD: the effects of switching to modified-release methylphenidate preparations on clinical outcomes and adherence

“…Also, the discrepancy between parent and teacher evaluation in the IOWA Conners scale may be due to both a pharmacokinetic weakness of the OROS ® MPH formulation in the morning (lower MPH availability) and a pharmacokinetic strength in the afternoon (better symptom control). In summary, one can agree with Heger et al [20] that ‘the results of this German sample suggest that children and adolescents with ADHD achieve at least as good control of central ADHD symptoms if there is a switch from MPH-IR to OROS ® MPH’.…”

“…The German subgroup of 50 patients was increased afterwards to 221 patients and data were analysed separately [20, 21]. In the first 3-week phase (European and German study), children benefited from switching formulations, but IOWA Conners scores improved only for parent ratings; teachers did not recognise a change in behaviour.…”

“…The global effectiveness evaluation was positive, i.e. ‘very good’ or ‘good’ (German study: teachers 55%, investigators 77%, parents 79%) [20]. Tolerability of OROS ® MPH was also good, with about 90% of parents favouring continuation of the MPH switch, a good predictor for better adherence in the long-term.…”

“…These results are notable because the preceding treatment with MPH-IR had already reduced the symptoms of ADHD. For comparison, a score of 10 is usual on the parent IOWA Conners scale inattention/hyperactivity for unmedicated children with ADHD [20]. In the OROS ® MPH study, the baseline score (i.e.…”

“…after treatment with MPH-IR, but before switching to MR) was 6.4, which decreased further to 4.2 after 21 days of treatment with OROS ® MPH. Thus, switching resulted in an additional statistically significant and clinically relevant treatment effect [20]. However, one should be cautious about drawing firm conclusions: this was an open study, the starting dose was heterogeneous and there was a tendency to increase doses while switching (which may be interpreted as dose optimisation).…”