Better efficacy for the osmotic release oral system methylphenidate among poor adherents to immediate-release methylphenidate in the three ADHD subtypes
Article first published online: 20 MAR 2009
© 2009 The Authors. Journal compilation © 2009 Japanese Society of Psychiatry and Neurology
Psychiatry and Clinical Neurosciences
Volume 63, Issue 2, pages 167–175, April 2009
How to Cite
Chou, W.-J., Chou, M.-C., Tzang, R.-F., Hsu, Y.-C., Gau, S. S.-F., Chen, S.-J., Wu, Y.-Y., Huang, Y.-F., Liang, H.-Y. and Cheng, H. (2009), Better efficacy for the osmotic release oral system methylphenidate among poor adherents to immediate-release methylphenidate in the three ADHD subtypes. Psychiatry and Clinical Neurosciences, 63: 167–175. doi: 10.1111/j.1440-1819.2009.01937.x
- Issue published online: 20 MAR 2009
- Article first published online: 20 MAR 2009
- Received 21 April 2008; revised 2 December 2008; accepted 8 December 2008.
- attention-deficit/hyperactivity disorder (ADHD);
- osmotic release oral system methylphenidate (OROS-MPH);
Aims: To determine factors for switching to osmotic release oral system methylphenidate (OROS-MPH) among poor adherents to immediate-release methylphenidate (IR-MPH); and to compare the efficacy of OROS-MPH on the three attention-deficit/hyperactivity disorder (ADHD) subtypes in a multi-site prospective observational study in Taiwan.
Methods: The sample included 240 children with ADHD, aged 6–16 years, who were poor adherents to IR-MPH, 137 of whom were switched to OROS-MPH. The child psychiatrists diagnosed the Diagnostic Statistical Manual of Mental Disorders (4th edition) ADHD subtypes and assessed the medical history, adherence, side-effects, global ADHD severity, and family/school effectiveness. Parents reported their child's behavioral symptoms.
Results: The determinants for an OROS-MPH switch were higher dosage, shorter treatment and thrice-daily administration of IR-MPH, and more severe inattention symptoms. Hyperactivity and oppositional symptoms were greater in the ADHD combined and hyperactive-impulsive subtypes than the inattentive subtype. Switching to OROS-MPH significantly improved behavioral symptoms and family/school measures, and this was most evident in the ADHD-combined group, followed by the ADHD-inattentive group. Inattention influenced not only academic performance, but also overall classroom behaviors and the parent–child relationship, with the latter two also influenced by oppositional symptoms.
Conclusions: This study suggests better efficacy for the OROS-MPH among poor adherents to IR-MPH; however, its effectiveness varied across the three ADHD subtypes (ClinicalTrials.gov number NCT00460720).