Differences in the Clinical Characteristics of Remission and Non-Remission Groups with Once-Daily OROS-Methylphenidate Treatment of Attention-Deficit/Hyperactivity Disorder
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Objective：Attention-deficit/hyperactivity disorder (ADHD) is a common, life-long condition associated with major functional impairment, and remission is the primary goal of treatment. The purpose of this study was to identify differences in the clinical characteristics of remission and non-remission groups composed of Korean children and adolescents with ADHD. Methods：Fifty-nine children and adolescents, 6-15 years old, diagnosed with ADHD according to the Diagnostic and Statistical Manual-IV (DSM-IV) criteria were included in the study. The study design was an 8-week, open-label trial of OROSmethylphenidate (OROS-MPH) monotherapy. The subjects were assessed using the Korean ADHD Rating Scale (K-ARS), Clinical Global Impression of Severity (CGI-S), Clinical Global Impression of Improvement (CGI-I), and Barkley Side Effect Rating Scale at baseline and 1, 2, 4, and 8 weeks after starting OROS-MPH treatment. Remission was defined as both a score of ≤2 on the CGI-S and a score of ≤18 on the K-ARS at the eighth week of the trial, when we examined the differences in the clinical characteristics between the remission and non-remission groups. Results：The remission rate at the eighth week was 47.5% (n=28). No differences were observed in the age, sex, weight, severity of symptoms reported by the parent, comorbidities at baseline, or doses of OROS-MPH at each evaluation point between the remission and non-remission groups. However, the non-remission group had higher scores in the CGI-S at baseline than the remission group. A difference in symptom improvement between the two groups began at the first week of the trial, and the remission group was less likely to have side effects at the eighth week. Conclusion：The results suggest that individual biological diversity may mediate different treatment responses to OROS-MPH. Interventions other than medication are needed to achieve remission and to restore proper functioning of patients with ADHD in the nonremission group.
Abstract
Objective：Attention-deficit/hyperactivity disorder (ADHD) is a common, life-long condition associated with major functional impairment, and remission is the primary goal of treatment. The purpose of this study was to identify differences in the clinical characteristics of remission and non-remission groups composed of Korean children and adolescents with ADHD. Methods：Fifty-nine children and adolescents, 6-15 years old, diagnosed with ADHD according to the Diagnostic and Statistical Manual-IV (DSM-IV) criteria were included in the study. The study design was an 8-week, open-label trial of OROSmethylphenidate (OROS-MPH) monotherapy. The subjects were assessed using the Korean ADHD Rating Scale (K-ARS), Clinical Global Impression of Severity (CGI-S), Clinical Global Impression of Improvement (CGI-I), and Barkley Side Effect Rating Scale at baseline and 1, 2, 4, and 8 weeks after starting OROS-MPH treatment. Remission was defined as both a score of ≤2 on the CGI-S and a score of ≤18 on the K-ARS at the eighth week of the trial, when we examined the differences in the clinical characteristics between the remission and non-remission groups. Results：The remission rate at the eighth week was 47.5% (n=28). No differences were observed in the age, sex, weight, severity of symptoms reported by the parent, comorbidities at baseline, or doses of OROS-MPH at each evaluation point between the remission and non-remission groups. However, the non-remission group had higher scores in the CGI-S at baseline than the remission group. A difference in symptom improvement between the two groups began at the first week of the trial, and the remission group was less likely to have side effects at the eighth week. Conclusion：The results suggest that individual biological diversity may mediate different treatment responses to OROS-MPH. Interventions other than medication are needed to achieve remission and to restore proper functioning of patients with ADHD in the nonremission group.
참고문헌 (30)
- Barkley RA, "The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study", J Am Acad Child Adolesc Psychiatry, 29, pp.546~557 (1990)
- Weiss G, "Psychiatric status of hyperactives as adults: a controlled prospective 15-year follow- up of 63 hyperactive children", J Am Acad Child Psychiatry, 24, pp.211~220 (1985)
- The MTA Cooperative Group, "A 14-month randomized clinical trial of treatment strategies for attention-deficit", hyperactivity disorder. Multimodal Treatment Study of Children with ADHD, 1999, pp.56, 1073~1086
- Swanson JM, "A comparison of once-daily extended-releasemethylphenidate formulations in children with attention-deficit", hyperactivity disorder in the laboratory school (the Comacs Study), 2004, pp.113, e206~e216
- Biederman J, "Pharmacotherapy for attention-deficit", hyperactivity disorder (ADHD) decreases the risk for substance abuse: findingsfrom a longitudinal follow-up of youths with and without ADHD, 2003, pp.64, 3~8
- Cox DJ, "Impact of methylphenidate delivery profiles on driving performance of adolescents with attention-deficit", hyperactivity disorder: a pilot study, 2004, pp.43, 269~275
- Greenhill LL, "Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults", J Am Acad Child Adolesc Psychiatry, 41, pp.26S~49S (2002)
- Swanson JM, "Efficacy of a new pattern of delivery of methylphenidate for the treatment of ADHD: effects on activity level in the classroom and on the playground", J Am Acad Child Adolesc Psychiatry, 41, pp.1306~1314 (2002)
- March JS, "The case for practical clinical trials in psychiatry", Am J Psychiatry, 162, pp.836~846 (2005)
- Swanson J, "Development of a new once-a-day formulation of methylphenidate for the treatment of attention-deficit", hyperactivity disorder: proof-of-concept and proof-of-product studies, 2003, pp.60, 204~211
- Pelham WE, "Once-a-day Concerta methylphenidate versus three-times-daily methylphenidate in laboratory and natural settings", Pediatrics, 107, pp.E105~ (2001)
- Wolraich ML, "Randomized, controlled trial of oros methylphenidate once a day in children with attention-deficit", hyperactivity disorder, 2001, pp.108, 883~892
- Steele M, "A randomized, controlled effectiveness trial of OROS-methylphenidate compared to usual care with immediate-release methylphenidate in attention deficit-hyperactivity disorder", Can J Clin Pharmacol, 13, pp.e50~e62 (2006)
- Steele M, "Remission versus response as the goal of therapy in ADHD: a new standard for the field", Clin Ther, 28, pp.1892~1908 (2006)
- Stein MA, "A dose-response study of OROS methylphenidate in children with attention-deficit", hyperactivity disorder, 2003, pp.112, e404~
- Swanson JM, "Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment", J Am Acad Child Adolesc Psychiatry, 40, pp.168~179 (2001)
- "Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV)" (1994), American Psychiatric Association
- 김영신, "The Reliability and Validity of Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version (K-SADS-PL-K)", Yonsei Medical Journal, 45(1), pp.81~89 (2004), 연세대학교의과대학
- 김영신, "한국어판 부모 및 교사용 ADHD 평가 척도(K-ARS)의 규준연구", 신경정신의학, 42(3), pp.352~359 (2003), 대한신경정신의학회
- Guy W, "ECDEU assessment manual for psychopharmacology, revised. Rockville" (1976), US Department of Health Education and Welfare
- Barkley RA, "Side effects of methylphenidate in children with attention deficit hyperactivity disorder: a systemic, placebo-controlled evaluation", Pediatrics, 86, pp.184~192 (1990)
- Lee SI, "Efficacy and tolerability of OROS methylphenidate in Korean children with attention-deficit", hyperactivity disorder, 2007, pp.31, 210~216
- 신지영, "주의력결핍과잉행동장애 아동에서 OROS-Methylphenidate의 처방현황과 효능 및 부모 인식: 4주 동안의 다기관 관찰 연구", 대한정신약물학회지, 18(1), pp.50~59 (2007), 대한정신약물학회
- 김봉석, "주의력결핍과잉운동장애 아동에게 methylphenidate-OROS 투여시 효용성과 안전성 및 부모 만족도를 평가하기 위한 다기관관찰연구", 소아 청소년 정신의학, 16(2), pp.279~285 (2005), 대한소아청소년정신의학회
- Kemner JE, "Outcomes of OROS methylphenidate compared with atomoxetine in children with ADHD: a multicenter, randomized prospective study", Adv Ther, 22, pp.498~512 (2005)
- Spencer T, "Efficacy of a mixed amphetamine salts compound in adults with attention-deficit", hyperactivity disorder, 2001, pp.58, 775~782
- Michelson D, "Once-daily atomoxetine treatment for children and adolescents with attention deficit hyperactivity disorder: a randomized, placebo-controlled study", Am J Psychiatry, 159, pp.1896~1901 (2002)
- Swanson JM, "Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatments", J Am Acad Child Adolesc Psychiatry, 40, pp.168~179 (2001)
- Wilens T, "ADHD treatment with once-daily OROS methylphenidate: interim 12-month results from a long-term open-label study", J Am Acad Child Adolesc Psychiatry, 42, pp.424~433 (2003)
- Gau SSF, "An open-label, randomized, active-controlled equivalent trial of osmotic release oral system methylphenidate in children with attention-deficit", hyperactivity disorder in Taiwan, 2006, pp.16, 441~455