TY - JOUR
T1 - Improving Methylphenidate Titration in Children with Attention-Deficit/Hyperactivity Disorder (ADHD)
T2 - A Randomized Controlled Trial Using Placebo-Controlled Titration Implemented in Clinical Practice
AU - Vertessen, Karen
AU - Luman, Marjolein
AU - Bet, Pierre
AU - Bergwerff, Catharina E.
AU - Bottelier, Marco
AU - Stoffelsen, Reino
AU - Swanson, James M.
AU - Wisse, Annemiek
AU - Twisk, Jos
AU - Oosterlaan, Jaap
N1 - Funding Information:
This study is part of the project ‘Reduce and optimize methylphenidate use in children and adolescents with ADHD’ (Grant p3119), funded by Innovation Fund of Health Insurances (Innovatiefonds Zorgverzekeraars). The funder/sponsor did not participate in the work.
Publisher Copyright:
© 2024, The Author(s), under exclusive licence to Springer Nature Switzerland AG.
PY - 2024
Y1 - 2024
N2 - Background and Objectives: Concerns exist regarding the rising use of methylphenidate. A double-blind, placebo-controlled methylphenidate titration (PCT) for children with attention-deficit/hyperactivity disorder (ADHD) has shown potential to improve titration (i.e., detection of placebo responders and larger ADHD symptom improvement) in experimental settings. This study aims to determine if these advantages can be transferred to clinical settings. Method: Children (aged 5–13 years) with an ADHD diagnosis and an indication to start methylphenidate (MPH) treatment were recruited. Participants were randomized to PCT or care as usual (CAU) in a 1:1 ratio followed by a 7-week randomized controlled trial (T1) and 6-month, naturalistic, open-label follow-up (T2). Parents, teachers, and physicians rated ADHD symptoms, ADHD medication use, MPH dosing, and treatment satisfaction using questionnaires. Results: A total of 100 children were enrolled and randomized to PCT (n = 49) or CAU (n = 51). In the PCT group, we found 8.2% placebo responders, 16.3% non-responders, and 65.3% responders to MPH. With PCT compared with CAU, a significantly larger number of children discontinued MPH (T1: 24.5 vs 5.9%, p = 0.009; T2: 41.7 vs 10.4%, p < 0.001) and refrained from using other pharmacological treatment (T1: 20.4 vs 3.9%, p = 0.013; T2: 20.83 vs 6.25%, p = 0.002). At both timepoints, there were no significant differences between the groups in the average dose of MPH, ADHD symptoms, or treatment satisfaction. Conclusions: PCT can be used to improve detection of children who do not benefit from MPH, and may therefore potentially reduce overtreatment of ADHD with MPH.
AB - Background and Objectives: Concerns exist regarding the rising use of methylphenidate. A double-blind, placebo-controlled methylphenidate titration (PCT) for children with attention-deficit/hyperactivity disorder (ADHD) has shown potential to improve titration (i.e., detection of placebo responders and larger ADHD symptom improvement) in experimental settings. This study aims to determine if these advantages can be transferred to clinical settings. Method: Children (aged 5–13 years) with an ADHD diagnosis and an indication to start methylphenidate (MPH) treatment were recruited. Participants were randomized to PCT or care as usual (CAU) in a 1:1 ratio followed by a 7-week randomized controlled trial (T1) and 6-month, naturalistic, open-label follow-up (T2). Parents, teachers, and physicians rated ADHD symptoms, ADHD medication use, MPH dosing, and treatment satisfaction using questionnaires. Results: A total of 100 children were enrolled and randomized to PCT (n = 49) or CAU (n = 51). In the PCT group, we found 8.2% placebo responders, 16.3% non-responders, and 65.3% responders to MPH. With PCT compared with CAU, a significantly larger number of children discontinued MPH (T1: 24.5 vs 5.9%, p = 0.009; T2: 41.7 vs 10.4%, p < 0.001) and refrained from using other pharmacological treatment (T1: 20.4 vs 3.9%, p = 0.013; T2: 20.83 vs 6.25%, p = 0.002). At both timepoints, there were no significant differences between the groups in the average dose of MPH, ADHD symptoms, or treatment satisfaction. Conclusions: PCT can be used to improve detection of children who do not benefit from MPH, and may therefore potentially reduce overtreatment of ADHD with MPH.
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U2 - 10.1007/s40272-023-00604-8
DO - 10.1007/s40272-023-00604-8
M3 - Article
AN - SCOPUS:85183401986
SN - 1174-5878
VL - 26
SP - 319
EP - 330
JO - Pediatric Drugs
JF - Pediatric Drugs
IS - 3
ER -