Abstract
BackgroundMethylphenidate (MPH) has been shown to be effective in the treatment of attention deficit hyperactivity disorder (ADHD) in children. The overall population of children and adolescents with ADHD may comprise distinct clusters of patients that differ in response to MPH. The aim of this analysis was to look for subgroups with different treatment trajectories and to identify their distinctive features.MethodsOBSEER was a prospective, observational study examining the effectiveness and safety of once-daily modified-release MPH over 3 months in patients (aged 6–17 years) with ADHD under routine care. Assessments were carried out at baseline (Visit 1), after 1–3 weeks (Visit 2) and 6–12 weeks (Visit 3) after first use of once-daily modified-release MPH. Change in ADHD symptoms, as rated by parents and teachers, was examined post hoc in patients of the intent-to-treat-population (N = 822), using growth-mixture modelling to detect response trajectory groups after switching medication. Age, MPH dose at Visit 1 before medication switch, prescribed once-daily modified-release MPH dose at Visits 1 and 2, conduct problems and emotional symptoms were considered predictors of response subgroups.ResultsAssessing formal statistical criteria and usefulness of the models, a 4-class solution best fitted the data: after switching medication two response groups with severe symptoms at study start and subsequent substantial treatment effects, and two showing no or comparatively little treatment effect, one of which had severe and the other less severe symptoms at study start. Patient age, conduct problems and MPH dose at Visit 1 were predictors of inclusion in subgroups.ConclusionsOlder children and children with few conduct problems were more likely to be members of a patient cluster with fewer symptoms at study start. Children with a low MPH dose before medication switch had a higher chance of being in the patient cluster with a strong treatment response after switching medication. The current analyses should assist in identifying children likely to achieve a favourable treatment course with MPH and, additionally, those who are in need of alternative treatment options.
Highlights
Methylphenidate (MPH) has been shown to be effective in the treatment of attention deficit hyperactivity disorder (ADHD) in children
Participants Patients aged 6–17 years with a confirmed diagnosis of ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) [33] or hyperkinetic disorder (HKD) according to the International Classification of Diseases, Version 10 (ICD 10) [34], who were attending school and for whom therapy with modified-release MPH (MR-MPH) (10, 20 or 30 mg once daily) was indicated and already intended by the attending physician, were eligible to participate in the study
The total population of children with ADHD – either previously treated or treatment naïve – receiving modified-release MPH under routine care conditions is best conceived as a composite of distinct subpopulations with varying treatment responses
Summary
Methylphenidate (MPH) has been shown to be effective in the treatment of attention deficit hyperactivity disorder (ADHD) in children. The overall population of children and adolescents with ADHD may comprise distinct clusters of patients that differ in response to MPH. The aim of this analysis was to look for subgroups with different treatment trajectories and to identify their distinctive features. For children with severe symptoms of attention deficit hyperactivity disorder (ADHD), methylphenidate (MPH) is one of the major treatment options. The response achieved by drug treatment varies among children with ADHD; some children will experience adequate symptom control, whereas for others benefits will be minor [12]. There is currently little information on response prediction in ADHD, and detecting and explaining differential treatment effects should be considered an important part of the general treatment research agenda [13,14]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
