title: A double-blind, placebo-controlled withdrawal trial of dexmethylphenidate hydrochloride in children with attention deficit hyperactivity disorder.
abstract: OBJECTIVE
  d,l-threo-methylphenidate HCl (D,L-MPH) is the most common treatment of attention deficit hyperactivity disorder (ADHD). A previous report showed placebo-controlled efficacy for the purified d-isomer (dexmethylphenidate hydrochloride, d-MPH, Focalin) with a 2:1 potency compared to dl, and suggested a 6-hour duration of action. This study complements that report by studying the effect of placebo-controlled discontinuation and retesting the duration of action.
  
  
  METHODS
  A 6-week, open-label titration of d-MPH (2.5-10 mg twice-a-day) was followed by a double-blind, placebo-controlled, 2-week withdrawal study of responders.
  
  
  RESULTS
  In the open titration, 82% of the 89 enrolled patients achieved a Clinical Global Impression-Improvement (CGI-I) rating of much or very much improved. Only 5 patients discontinued for adverse events. Seventy-five patients continued into the placebo-controlled discontinuation. For the randomly assigned d-MPH (n=35) and placebo (n=40) groups, mean ages, respectively, were 10.1 +/- 2.9 and 9.9 +/- 2.7 years, 86% and 78% were male, and 70.6% and 80.0% took the ceiling dose of 10 mg twice-daily, respectively. Each group had 80% combined type ADHD and 20% inattentive type. By the end of the 2-week, placebo-masked withdrawal, significantly more placebo patients (24 of 39) than d-MPH continuers (6 of 35) relapsed (61.5% versus 17.1%, p=0.001). Compared to d-MPH continuers, placebo patients deteriorated significantly more in the 2-week period on teacher ratings of the 18 ADHD symptoms rated 0-3 (p=0.028), the 3 p.m. and 6 p.m. parent ADHD symptom ratings (p=0.0026 and p=0.0381, respectively), and clinic (2-3 p.m.) and home (6 p.m.) Math Tests (p=0.024 and p<0.0001, respectively). The 6 p.m. scores replicated the significant effect at 6 hours reported in the previous study.
  
  
  CONCLUSIONS
  d-MPH is safe, tolerable, and effective, with a 6-hour duration of effect suggested by the significant difference from placebo at 6 hours on a double-blind discontinuation.
authors.affiliation: Ohio State University, Columbus, Ohio 43210-1296, USA. arnold.6@osu.edu
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Arnold
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Lindsay
authors.forename: C Keith
authors.initials: CK
authors.lastname: Conners
authors.forename: Sharon B
authors.initials: SB
authors.lastname: Wigal
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Levine
authors.forename: Diane E
authors.initials: DE
authors.lastname: Johnson
authors.forename: Scott A
authors.initials: SA
authors.lastname: West
authors.forename: R Bart
authors.initials: RB
authors.lastname: Sangal
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Bohan
authors.forename: Jerome B
authors.initials: JB
authors.lastname: Zeldis
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage* / Q000737:chemistry / Q000493:pharmacokinetics*; D002648:Child; D064699:Dexmethylphenidate Hydrochloride; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage* / Q000737:chemistry / Q000493:pharmacokinetics*; D011569:Psychiatric Status Rating Scales; D013237:Stereoisomerism; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D000697:Central Nervous System Stimulants; D064699:Dexmethylphenidate Hydrochloride; D008774:Methylphenidate