Using long-acting stimulants: does it change ADHD treatment outcome?

Introduction: 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 Adderall XR(R), an extended-release formulation of mixed amphetamine salts, has recently been withdrawn from the market.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.