Comparison of Efficacy and Tolerability of Modified Release Methylphenidate, Osmotic-Release Methylphenidate and Atomoxetine in Children with Attention Deficit Hyperactivity Disorder

Year 2019, , 71 - 76, 01.01.2019

Serkan Gunes

https://doi.org/10.5455/umj.20191130053404

Abstract

Background: Attention deficit hyperactivity disorder ADHD is a common psychiatric condition that affects the daily functioning of children, adolescents, and adults. In this study, we aim to determine the efficacy and tolerability of medications that frequently use in the treatment of ADHD. Materials and Methods: 204 primary school-age children with documented DSM-5 ADHD diagnosis were included. Clinical characteristics of the sample were obtained from the medical records and structured psychiatric interviews. Improvement and side effects were assessed with the Clinical Global Impression-Improvement Scale CGI-I and the adverse effect scale developed by the authors, respectively. Results: Mean age of the patients was 8.32±1.15 and 67.1% of the patients were male. 33.3% of the patients were using modified-release methylphenidate, 35.3% were using osmotic-release methylphenidate, and 31.4% were using Atomoxetine. The CGI-I was significantly different between the three groups p=0.012 . There was no significance in terms of treatment compliance. Sleep disturbances, appetite, and sadness were different between the groups. Conclusion: Atomoxetine seems to be less effective and has fewer side effects than modified-release methylphenidate and osmotic-release methylphenidate. Modified release methylphenidate and osmotic-release methylphenidate appear to show similar effectiveness. Osmotic release methylphenidate may be associated with more and severe side effects.

Keywords

ADHD, methylphenidate, atomoxetine, efficacy, tolerability

References

• Ozbaran B, Kose S, Yuzuguldu O, Atar B, Aydin C. Combined methylphenidate and atomoxetine pharmacotherapy in attention deficit hyperactivity disorder. World J Biol Psychiatry. 2015;16(8):619–24
• Kratochvil CJ, Heiligenstein JH, Dittmann R, Spencer TJ, Biederman J, Wernicke J, et al. Atomoxetine and Methylphenidate Treatment in Children With ADHD: A Prospective, Randomized, Open-Label Trial. J Am Acad Child Adolesc Psychiatry. 2002;41(7):776–84
• Liu Q, Zhang H, Fang Q, Qin L. Comparative efficacy and safety of methylphenidate and atomoxetine for attention- deficit hyperactivity disorder in children and adolescents: Meta-analysis based on head-to-head trials. J Clin Exp Neuropsychol.2017;39(9):854-65
• Madhusoodanan S, Goia D. Rapid resolution of depressive symptoms with methylphenidate augmentation of mirtazapine in an elderly depressed hospitalized patient: a case report. Clin Pract. 2014;11(3):283
• Garg J, Arun P, Chavan BS. Comparative short term efficacy and tolerability of methylphenidate and atomoxetine in attention deficit hyperactivity disorder. Indian Pediatr. 2014;51(7):550–4
• Su Y, Yang L, Stein MA, Cao Q, Wang Y. Osmotic Release Oral System Methylphenidate Versus Atomoxetine for the Treatment of Attention-Deficit/Hyperactivity Disorder in Chinese Youth: 8-Week Comparative Efficacy and 1-Year Follow-Up. J Child Adolesc Psychopharmacol. 2016;26 (4):362–71
• Yildiz O, Sismanlar SG, Memik NC, Karakaya I, Agaoglu B. Atomoxetine and Methylphenidate Treatment in Children with ADHD: The Efficacy, Tolerability and Effects on Executive Functions. Child Psychiatry Hum Dev. ;42(3):257–69 Newcorn JH, Kratochvil CJ, Allen AJ, Casat CD, Ruff DD, Moore RJ, et al. Atomoxetine and Osmotically Released Methylphenidate for the Treatment of Attention Deficit Hyperactivity Disorder: Acute Comparison and Differential Response. Am J Psychiatry. 2008;165(6):721–30
• Kemner JE, Starr HL, Ciccone PE, Hooper-Wood CG, Crockett RS. Outcomes of OROS methylphenidate compared with atomoxetine in children with ADHD: a multicenter, randomized prospective study. Adv Ther. ;22(5):498–512 Sonuga-Barke EJS, Coghill D, DeBacker M, Swanson J. Measuring Methylphenidate Response in Attention- Deficit/Hyperactvity Disorder: How Are Laboratory Classroom-Based Measures Related to Parent Ratings? J Child Adolesc Psychopharmacol. 2009;19(6):691–8
• Döpfner M, Ose C, Fischer R, Ammer R, Scherag A. Comparison of the Efficacy of Two Different Modified Release Methylphenidate Preparations for Children and Adolescents with Attention-Deficit/Hyperactivity Disorder in a Natural Setting: Comparison of the Efficacy of Medikinet Retard and Concerta Randomized, Controlled, Double-Blind Multicenter Clinical Crossover Trial. J Child Adolesc Psycho pharmacol. 2011;21(5):445–54
• Wolff C, Alfred A, Lindermüller A, Rettig K, Mattejat F, Gerwe M, et al. Effect of transitioning from extended- release methylphenidate onto osmotic, controlled-release methylphenidate in children/ adolescents with ADHD: results of a 3-month non-interventional study. Curr Med Res Opin. 2011;27 (sup2):35–44
• Shang C-Y, Pan Y-L, Lin H-Y, Huang L-W, Gau SS-F. An Open-Label, Randomized Trial of Methy lphenidate and Atomoxetine Treatment in Children with Attention- Deficit/Hyperactivity Disorder. J Child Adolesc Psycho pharmacol. 2015;25(7):566–73
• Biederman J, Heiligenstein JH, Faries DE, Galil N, Dittmann R, Emslie GJ, et al. Efficacy of atomoxetine versus placebo in school-age girls with attention-deficit/hyperactivity disorder. Pediatrics. 2002;110 (6):e75