Abstract
Adults with attention-deficit/hyperactivity disorder (ADHD) often face delays in diagnosis and remain untreated, despite significant negative impacts. To evaluate the safety and efficacy of transdermal treatment options in children, adolescents, and adults, a systematic literature review was conducted, with a focus on the implications of transdermal therapies for ADHD in adults. A MEDLINE/Embase/BIOSIS/SCOPUS database search was conducted December 4, 2019, for English-language articles of interventional clinical trials using transdermal formulations for the treatment of ADHD without publication date limit. Assessed outcomes included efficacy, safety, adherence, abuse potential, cost efficacy, and health-related quality of life. Of 23 eligible publications, 18 were in children or adolescents (n=1699; range 23-305), and 5 in adults (n=274; range 14-90); all included methylphenidate transdermal system (MTS). All seven pediatric publications reporting change in ADHD symptomology from baseline reported a significant improvement with MTS treatment. Similarly, in three adult publications, ADHD symptoms improved significantly with MTS treatment. Safety findings in pediatric and adult studies were comparable; the most frequently reported treatment-emergent adverse events (TEAEs), namely, headache, decreased appetite, and insomnia, were reported in 13/16 (81%) of publications reporting specific TEAEs. MTS-related dermal reactions were mostly mild and transient. Discontinuation due to dermal reactions was reported in 10 studies (range 0%-7.1% [1 of 14 patients]). MTS compliance was high when assessed (97%-99%). Transdermal therapies provide a useful treatment formulation for ADHD. Studies of MTS and other transdermal formulations, such as amphetamine, in adult patients are needed in this underserved population.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is a relatively common disorder, characterized by inattention, hyperactivity, and impulsivity.[1]
The impact of treatment on severity of attention-deficit/hyperactivity disorder (ADHD) symptoms was assessed in 17 publications; the 6 papers that did not evaluate ADHD symptoms focused on sleep,[35] effect of patch placement on pharmacokinetics/pharmacodynamics,[43] effect of formulation on pharmacokinetics/pharmacodynamics,[49] and HRQoL improvements.[32,41,42]
Among the publications related to adults with ADHD, 4 of 5 studies used the Wender–Reimherr Adult Attention Deficit Disorder Scale (WRAADDS), which is based on the Utah Criteria for ADHD in adults and measures ADHD symptom severity in the following seven domains: attention difficulties, hyperactivity/ restlessness, temper, affective lability, emotional over-reactivity, disorganization, and impulsivity
Summary
Attention-deficit/hyperactivity disorder (ADHD) is a relatively common disorder, characterized by inattention, hyperactivity, and impulsivity.[1]. Of 23 eligible publications, 18 were in children or adolescents (n = 1699; range 23-305), and 5 in adults (n = 274; range 14-90); all included methylphenidate transdermal system (MTS). All seven pediatric publications reporting change in ADHD symptomology from baseline reported a significant improvement with MTS treatment. In three adult publications, ADHD symptoms improved significantly with MTS treatment. Safety findings in pediatric and adult studies were comparable; the most frequently reported treatment-emergent adverse events (TEAEs), namely, headache, decreased appetite, and insomnia, were reported in 13/16 (81%) of publications reporting specific TEAEs. MTS-related dermal reactions were mostly mild and transient. Studies of MTS and other transdermal formulations, such as amphetamine, in adult patients are needed in this underserved population
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