Long-acting methylphenidate formulations in the treatment of attention-deficit/hyperactivity disorder: a systematic review of head-to-head studies

BMC Psychiatry

Manfred Doepfner¹  Antonella Gagliano⁴  Antonio Pelaz⁵  Alessandro Zuddas³  Tobias Banaschewski²  David Coghill⁶ 

[1] Department of Child and Adolescent Psychiatry, University of Cologne, Cologne, Germany;Department of Child and Adolescent Psychiatry, Central Institute of Mental Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany;Department of Biomedical Sciences, University of Cagliari, Cagliari, Sardinia, Italy;Department of Pediatric Science, University of Messina, Policlinico Universitario G. Martino, Messina, Italy;Department of Child and Adolescent Psychiatry, Hospital Clinico Universitario San Carlos, Madrid, Spain;Division of Neuroscience, Medical Research Institute, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK

关键词: Review;    Pharmacokinetics;    Long-acting formulation;    Comparison;    Attention-deficit/hyperactivity disorder;    Methylphenidate;   

Others  :  1123956
DOI  :  10.1186/1471-244X-13-237

 received in 2013-02-24, accepted in 2013-09-11,  发布年份 2013

【 摘 要 】

Background

The stimulant methylphenidate (MPH) has been a mainstay of treatment for attention-deficit/hyperactivity disorder (ADHD) for many years. Owing to the short half-life and the issues associated with multiple daily dosing of immediate-release MPH formulations, a new generation of long-acting MPH formulations has emerged. Direct head-to-head studies of these long-acting MPH formulations are important to facilitate an evaluation of their comparative pharmacokinetics and efficacy; however, to date, relatively few head-to-head studies have been performed.

The objective of this systematic review was to compare the evidence available from head-to-head studies of long-acting MPH formulations and provide information that can guide treatment selection.

Methods

A systematic literature search was conducted in MEDLINE and PsycINFO in March 2012 using the MeSH terms: attention deficit disorder with hyperactivity/drug therapy; methylphenidate/therapeutic use and All Fields: Concerta; Ritalin LA; OROS and ADHD; Medikinet; Equasym XL and ADHD; long-acting methylphenidate; Diffucaps and ADHD; SODAS and methylphenidate. No filters were applied and no language, publication date or publication status limitations were imposed. Articles were selected if the title indicated a comparison of two or more long-acting MPH preparations in human subjects of any age; non-systematic review articles and unpublished data were not included.

Results

Of 15,295 references returned in the literature search and screened by title, 34 articles were identified for inclusion: nine articles from pharmacokinetic studies (nine studies); nine articles from laboratory school studies (six studies); two articles from randomized controlled trials (two studies); three articles from switching studies (two studies) and three articles from one observational study.

Conclusions

Emerging head-to-head studies provide important data on the comparative efficacy of the formulations available. At a group level, efficacy across the day generally follows the pharmacokinetic profile of the MPH formulation. No formulation is clearly superior to another; careful consideration of patient needs and subtle differences between formulations is required to optimize treatment. For patients achieving suboptimal symptom control, switching long-acting MPH formulations may be beneficial. When switching formulations, it is usually appropriate to titrate the immediate-release component of the formulation; a limitation of current studies is a focus on total daily dose rather than equivalent immediate-release components. Further studies are necessary to provide guidance in clinical practice, particularly in the treatment of adults and pre-school children and the impact of comorbidities and symptom severity on treatment response.

【 授权许可】

   
2013 Coghill et al.; licensee BioMed Central Ltd.

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