Clinical gains from including both dextroamphetamine and methylphenidate in stimulant trials
Bjørn E Ramtvedt1, Elisabeth Røinås, Henning S Aabech
11 Østfold Hospital Trust , Neuropsychiatric Unit, Fredrikstad, Norway .
Insights
Including both dextroamphetamine and methylphenidate in attention-deficit/hyperactivity disorder (ADHD) trials improves treatment outcomes. This approach increases the number of children who respond favorably to medication and enhances overall response strength.
Area of Science:
- Neuroscience
- Psychiatry
- Pediatrics
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children.
- Stimulant medications like methylphenidate and dextroamphetamine are primary treatments for ADHD.
- Individual responses to stimulants can vary, necessitating personalized treatment approaches.
Purpose of the Study:
- To investigate the clinical benefits of including both dextroamphetamine and methylphenidate in stimulant trials for ADHD.
- To determine if combining these stimulants in a trial maximizes treatment gains for children with ADHD.
Main Methods:
- A 6-week crossover trial involving 36 medication-naïve children (ages 9-14) diagnosed with ADHD.
- Participants received methylphenidate, dextroamphetamine, and placebo in a randomized, counterbalanced sequence.
- Outcomes were measured using the Qb Test (continuous performance test with motion tracking) and ADHD rating scales completed by parents and teachers.
Main Results:
- Both dextroamphetamine and methylphenidate showed significant treatment effects of similar magnitude on ADHD symptoms.
- Individually, 72% of children responded favorably to at least one stimulant.
- Including both stimulants in the trial increased the proportion of favorable responders to 92% and improved response strength by 64% in some cases.
Conclusions:
- Including both dextroamphetamine and methylphenidate in stimulant trials enhances the likelihood of a favorable and optimal treatment response in children with ADHD.
- This strategy maximizes the identification of effective stimulant medication for individual children.
- Personalized stimulant selection is crucial for optimizing ADHD treatment outcomes.
Objective:
The purpose of this study was to investigate clinical gains from including both dextroamphetamine and methylphenidate in stimulant trials.
Method:
Thirty-six medication-naïve children ages 9-14 years diagnosed with attention-deficit/hyperactivity disorder (ADHD) were enrolled for 6 weeks in a crossover trial, with 2 weeks of methylphenidate, dextroamphetamine, and placebo, in a randomly assigned, counterbalanced sequence. Outcome measures constituted a computer-based continuous performance test combined with a motion tracking system (Qb Test) and an ADHD questionnaire rated by parents and teachers.
Results:
Group analyses found significant treatment effects of similar size for the two stimulants on both outcome measures. Single-subject analyses revealed that each stimulant produced a favourable response in 26 children; however, an individual child frequently responded qualitatively or quantitatively differently to the two stimulants. By including both stimulants in the trial, the number of favorable responders increased from 26 (72%) to 33 (92%). In children with favorable responses of unequal strength to the two stimulants, a shift from inferior drug to best drug was associated with a 64% mean increase in the overall response strength score, as measured by the ADHD questionnaire.
Conclusions:
The likelihood of a favorable response and optimal response strength is increased by including both stimulants in the stimulant trial. The study was first registered in clinical trials 28 September 2010. Clinical Trials.gov Identifier: NCT01220440.
More Related Videos
09:16A General Method for Evaluating Deep Brain Stimulation Effects on Intravenous Methamphetamine Self-Administration
Published on: January 22, 2016
07:02A Computerized Test Battery to Study Pharmacodynamic Effects on the Central Nervous System of Cholinergic Drugs in Early Phase Drug Development
Published on: February 11, 2019
Related Concept Videos
01:28Adrenergic Agonists: Mixed-Action Agents
Ephedrine and pseudoephedrine lack a catecholamine group, making them less susceptible to degradation by metabolic enzymes. They have increased oral bioavailability and lipophilicity, resulting in a longer duration of action. Their response is reduced by...
01:29Stimulants
Cocaine can be administered via snorting, injection, or smoking. It primarily functions by blocking the reuptake of dopamine, resulting in a euphoric high characterized by an intense sensation of happiness and...
01:30Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings.
01:25Adrenergic Agonists: Indirect-Acting Agents
One mechanism involves depleting stored catecholamines by displacing them from synaptic vesicles. These agents, known as "displacers," are transported into vesicles at the expense of noradrenaline. Examples include amphetamine and tyramine, which lack a catechol moiety, resulting in prolonged action, improved oral bioavailability, and...
01:24CNS Stimulants: Cocaine, Amphetamines and Cannabinoids
01:23Drugs Acting on Autonomic Ganglia: Stimulants
Ganglionic stimulants activate NM nicotinic receptors in autonomic ganglia, falling into two categories: nicotine mimetics [e.g., lobeline, dimethylpiperazine, tetramethylammonium] and muscarinic receptor agonists [e.g., muscarine, methacholine]. The first category's action is rapid and blocked by nicotinic receptor antagonists, while the second category's action is delayed and blocked by atropine-like agents. Nicotine, an alkaloid, affects the heart rate by stimulating sympathetic or...