Comparative short term efficacy and tolerability of methylphenidate and atomoxetine in attention deficit
Jasmin Garg1, Priti Arun, B S Chavan
1Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India. Correspondence to: Dr Jasmin Garg, Department of Psychiatry, Government Medical College and Hospital, Sector 32, Chandigarh, India. jasmin.arneja@gmail.com.
Insights
Methylphenidate and atomoxetine are effective treatments for Attention Deficit Hyperactivity Disorder (ADHD) in Indian children. Both medications demonstrated comparable short-term efficacy and tolerability, with observed differences in side effects like weight loss and heart rate changes.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Pharmacology
Background:
- Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder in children.
- Pharmacological interventions, including methylphenidate and atomoxetine, are primary treatment options.
- Comparative efficacy and tolerability data in diverse populations, such as Indian children, are crucial for optimizing treatment strategies.
Purpose of the Study:
- To compare the short-term efficacy and tolerability of methylphenidate and atomoxetine in children diagnosed with ADHD.
- To evaluate treatment response rates and adverse effects of both medications in a pediatric population in Northern India.
Main Methods:
- An open-label, randomized, parallel-group clinical trial was conducted.
- 69 children (aged 6-14 years) diagnosed with ADHD received either methylphenidate or atomoxetine for eight weeks.
- Treatment response was assessed using the Vanderbilt ADHD Diagnostic Parent and Teacher Rating Scales (VADPRS/VADTRS) and the Clinical Global Impression Severity Scale (CGI-S), alongside monitoring adverse effects.
Main Results:
- Both methylphenidate (90.7%) and atomoxetine (86.2%) showed high treatment response rates.
- Comparable improvements were observed across VADPRS, VADTRS, and CGI-S scores between the two groups (P>0.05).
- Methylphenidate was associated with significantly higher weight loss (P=0.001), while atomoxetine showed a higher rate of heart rate increase (P=0.021).
Conclusions:
- Methylphenidate and atomoxetine are efficacious for treating ADHD in Indian children, potentially at lower doses than previously established.
- The study demonstrates comparable short-term efficacy and tolerability between methylphenidate and atomoxetine in this population.
- Observed differences in side effect profiles (weight loss with methylphenidate, heart rate increase with atomoxetine) warrant consideration during treatment selection.
Objective:
To compare the short term efficacy and tolerability of methylphenidate and atomoxetine in children with Attention deficit hyperactivity disorder (ADHD).
Design:
Open label randomized parallel group clinical trial.
Setting:
Child Guidance Clinic of a tertiary care hospital of Northern India from October 2010 to June 2012.
Participants:
69 patients (age 6-14 y) with a diagnosis of ADHD receiving methylphenidate or atomoxetine.
Intervention:
Methylphenidate (0.2-1 mg/kg/d) or atomoxetine (0.5-1.2 mg/kg/d) for eight weeks.
Main Outcome Measures:
Treatment response (>25% change in baseline Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS); Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS); Clinical Global Impression Severity Scale (CGI-S) at eight weeks and adverse effects.
Results:
Treatment response was observed in 90.7% patients from methylphenidate group and 86.2% patients of atomoxetine group at an average dose of 0.45 mg/kg/d and 0.61 mg/kg/d, respectively. The patients showed comparable improvement on VADPRS (P=0.500), VADTRS (P=0.264) and CGI-S (P=0.997). Weight loss was significantly higher in methylphenidate group (-0.57±0.78 kg; P=0.001), and heart rate increase was observed at higher rate in atomoxetine group (7± 9 bpm; P=0.021).
Conclusions:
Methylphenidate and atomoxetine are efficacious in Indian children with ADHD at lesser doses than previously used. Their efficacy and tolerability are comparable. TRIAL REGISTRATION NO.: CTRI/2011/08/001981.
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