title: Remission in children and adolescents diagnosed with attention-deficit/hyperactivity disorder via an effective and tolerable titration scheme for osmotic release oral system methylphenidate.
abstract: OBJECTIVE
  The purpose of this study was to identify the optimal dose of osmotic release oral system methylphenidate (OROS-MPH) using a dosage forced-titration scheme to achieve symptomatic remission in children with attention- deficit/hyperactivity disorder (ADHD). We also evaluated the efficacy and safety of, and patient and parent satisfaction with, the change in therapy from immediate-release methylphenidate (IR-MPH) to OROS-MPH over 10 weeks.
  
  
  METHODS
  We recruited 521 children and adolescents aged 6-18 years with an American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) diagnosis of ADHD, who had received IR-MPH treatments (<70 mg/day) for at least 1 month. The treatment, switched from IR-MPH to OROS-MPH according to a conversion scheme, started with a 6-week forced-titration phase of OROS-MPH to achieve symptomatic remission (defined as a score of 0 or 1 for each of the first 18 ADHD items in the Chinese version of the Swanson, Nolan, and Pelham, Version IV [SNAP-IV]), followed by a 4-week maintenance phase. The global ADHD severity and drug side effects of the participants were evaluated. Parents completed the ratings scales for the ADHD-related symptoms. Patient and parent satisfaction for the OROS-MPH treatment was also assessed.
  
  
  RESULTS
  Among the 439 participants with ADHD who completed the trial, 290 participants (66.1%) achieved symptomatic remission. The mean dose of OROS-MPH among participants in remission was 36.7 mg (1.08 mg/kg) per day. Increased efficacy, superior satisfaction, and safety equivalent to that of IR-MPH were demonstrated in intra-individual comparisons from the baseline to the end of study. Determinants for remission included less severe ADHD symptoms (SNAP-IV score < 40), no family history of ADHD, and an appropriate dosage of medication according to the patient's weight.
  
  
  CONCLUSIONS
  The findings suggest remission as a treatment goal for ADHD therapy by providing an optimal dosage of medication for children and adolescents with ADHD through using an effective and tolerable forced-titration scheme.
authors.affiliation: Department of Child Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Wen-Jiun
authors.initials: WJ
authors.lastname: Chou
authors.forename: Shin-Jaw
authors.initials: SJ
authors.lastname: Chen
authors.forename: Ying-Sheue
authors.initials: YS
authors.lastname: Chen
authors.forename: Hsin-Yi
authors.initials: HY
authors.lastname: Liang
authors.forename: Chih-Chien
authors.initials: CC
authors.lastname: Lin
authors.forename: Ching-Shu
authors.initials: CS
authors.lastname: Tang
authors.forename: Yu-Shu
authors.initials: YS
authors.lastname: Huang
authors.forename: Chin-Bin
authors.initials: CB
authors.lastname: Yeh
authors.forename: Miao-Chun
authors.initials: MC
authors.lastname: Chou
authors.forename: Dai-Yueh
authors.initials: DY
authors.lastname: Lin
authors.forename: Po-Hsun
authors.initials: PH
authors.lastname: Hou
authors.forename: Yu-Yu
authors.initials: YY
authors.lastname: Wu
authors.forename: Hung-Jen
authors.initials: HJ
authors.lastname: Liu
authors.forename: Ya-Fen
authors.initials: YF
authors.lastname: Huang
authors.forename: Kai-Ling
authors.initials: KL
authors.lastname: Hwang
authors.forename: Chin-Hong
authors.initials: CH
authors.lastname: Chan
authors.forename: Chia-Ho
authors.initials: CH
authors.lastname: Pan
authors.forename: Hsueh-Ling
authors.initials: HL
authors.lastname: Chang
authors.forename: Chi-Fen
authors.initials: CF
authors.lastname: Huang
authors.forename: Ju-Wei
authors.initials: JW
authors.lastname: Hsu
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000503:physiopathology; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009997:Osmotic Pressure; D010290:Parents / Q000523:psychology; D017060:Patient Satisfaction; D011446:Prospective Studies; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants; D003692:Delayed-Action Preparations; D008774:Methylphenidate