Remission in children and adolescents diagnosed with attention-deficit/hyperactivity disorder via an effective and tolerable titration scheme for osmotic release oral system methylphenidate

• Published in: Journal of child and adolescent psychopharmacology Vol. 22; no. 3; pp. 215 - 225
• Main Authors: Chou, Wen-Jiun, Chen, Shin-Jaw, Chen, Ying-Sheue, Liang, Hsin-Yi, Lin, Chih-Chien, Tang, Ching-Shu, Huang, Yu-Shu, Yeh, Chin-Bin, Chou, Miao-Chun, Lin, Dai-Yueh, Hou, Po-Hsun, Wu, Yu-Yu, Liu, Hung-Jen, Huang, Ya-Fen, Hwang, Kai-Ling, Chan, Chin-Hong, Pan, Chia-Ho, Chang, Hsueh-Ling, Huang, Chi-Fen, Hsu, Ju-Wei
• Format: Journal Article
• Language: English
• Published: United States Mary Ann Liebert, Inc 01.06.2012
• Subjects: Administration, Oral; Adolescent; Attention Deficit Disorder with Hyperactivity - drug therapy; Attention Deficit Disorder with Hyperactivity - physiopathology; Attention deficit hyperactivity disorder; Central Nervous System Stimulants - administration & dosage; Central Nervous System Stimulants - adverse effects; Central Nervous System Stimulants - therapeutic use; Child; Children & youth; Delayed-Action Preparations; Dose-Response Relationship, Drug; Drug dosages; Drug therapy; Female; Humans; Male; Methylphenidate - administration & dosage; Methylphenidate - adverse effects; Methylphenidate - therapeutic use; Original; Osmotic Pressure; Parents - psychology; Patient Satisfaction; Prospective Studies; Remission Induction; Severity of Illness Index; Treatment Outcome
• ISSN: 1044-5463; 1557-8992
• DOI: 10.1089/cap.2011.0006

The purpose of this study was to identify the optimal dose of osmotic release oral system methylphenidate (OROS-MPH) using a dosage forced-titration scheme to achieve symptomatic remission in children with attention- deficit/hyperactivity disorder (ADHD). We also evaluated the efficacy and safety of, and patient and parent satisfaction with, the change in therapy from immediate-release methylphenidate (IR-MPH) to OROS-MPH over 10 weeks. We recruited 521 children and adolescents aged 6-18 years with an American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) diagnosis of ADHD, who had received IR-MPH treatments (<70 mg/day) for at least 1 month. The treatment, switched from IR-MPH to OROS-MPH according to a conversion scheme, started with a 6-week forced-titration phase of OROS-MPH to achieve symptomatic remission (defined as a score of 0 or 1 for each of the first 18 ADHD items in the Chinese version of the Swanson, Nolan, and Pelham, Version IV [SNAP-IV]), followed by a 4-week maintenance phase. The global ADHD severity and drug side effects of the participants were evaluated. Parents completed the ratings scales for the ADHD-related symptoms. Patient and parent satisfaction for the OROS-MPH treatment was also assessed. Among the 439 participants with ADHD who completed the trial, 290 participants (66.1%) achieved symptomatic remission. The mean dose of OROS-MPH among participants in remission was 36.7 mg (1.08 mg/kg) per day. Increased efficacy, superior satisfaction, and safety equivalent to that of IR-MPH were demonstrated in intra-individual comparisons from the baseline to the end of study. Determinants for remission included less severe ADHD symptoms (SNAP-IV score < 40), no family history of ADHD, and an appropriate dosage of medication according to the patient's weight. The findings suggest remission as a treatment goal for ADHD therapy by providing an optimal dosage of medication for children and adolescents with ADHD through using an effective and tolerable forced-titration scheme.