Using long-acting stimulants: does it change ADHD treatment outcome?
BACKGROUND
Over 30% of children with ADHD treated with a rigorous multimodal intervention in the MTA study did not reach full functional remission. New long-acting drugs have been developed with this treatment goal in mind.


METHODS
Presentations at the 2004 Annual Meeting of the Canadian Academy of Child and Adolescent Psychiatry discussed the development of long-acting drugs for ADHD and clinical studies of their efficacy; these presentations are summarized below.


RESULTS
Concerta(R) OROS-MPH releases methylphenidate (MPH) in an initial bolus, followed by increasing concentrations throughout the day. This pattern of drug delivery overcomes the development of acute tolerance; classroom analog studies have shown that ADHD symptoms and academic productivity are thereby maintained for 12 hours. A larger open-label study showed that efficacy was maintained through the 12-month study period. An 8-week open-label trial found that OROS-MPH produced significantly higher remission rates than immediate-release MPH (44% vs 16%; p = 0.0002), as well as significantly higher Clinical Global Impression and parent satisfaction scores. Adderall XR(R), an extended-release formulation of mixed amphetamine salts, has recently been withdrawn from the market.


CONCLUSIONS
Long-acting stimulant formulations have dramatically changed the landscape of ADHD practice.
Swanson
James M
JM
Professor of Pediatrics, UCI Child Development Center, Centerpointe Plaza, 19722 MacArthur Blvd., University of California at Irvine, Irvine, California 92612, (949) 824-1822 (Phone), (949) 824-1811 (Fax), jmswanso@uci.edu (Email).
Hechtman
Lily
L