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Multisite Controlled Study of OROS Methylphenidate in the Treatment of Adolescents With Attention-Deficit/Hyperactivity Disorder
Timothy E. Wilens, MD;
Keith McBurnett, PhD;
Oscar Bukstein, MD;
James McGough, MD;
Laurence Greenhill, MD;
Marc Lerner, MD;
Mark A. Stein, PhD;
C. Keith Conners, PhD;
John Duby, MD;
Jeffrey Newcorn, MD;
Charles E. Bailey, MD;
Christopher J. Kratochvil, MD;
Daniel Coury, MD;
Charles Casat, MD;
Mary Joan C. Denisco, PharmD;
Patricia Halstead, MD;
Leslie Bloom, BS;
Brenda A. Zimmerman, MS;
Joan Gu, MS;
Kimberly M. Cooper, MS;
Joseph M. Lynch, MD
Arch Pediatr Adolesc Med. 2006;160:82-90.
Background Despite the persistence of attention-deficit/hyperactivity disorder (ADHD) into adolescence, little is known about the efficacy and tolerability of stimulant medications in this age group.
Objective To report the results of a multisite controlled study among adolescents with ADHD evaluating the efficacy and tolerability of osmotic-release oral system (OROS) methylphenidate.
Design Adolescents (N = 220) having a confirmed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of ADHD underwent dose titration to identify dosages of OROS methylphenidate that improved symptoms to predefined criteria. Subjects successfully completing the dose titration phase (n = 177) (ie, tolerated and responded to treatment and adhered to the protocol) were randomized to receive 2 weeks’ treatment with their individualized dosage of OROS methylphenidate (18, 36, 54, or 72 mg once daily) or placebo. Treatment effectiveness was measured using investigator, parent, and adolescent assessments of ADHD.
Results A significant reduction from baseline in the investigator-rated ADHD Rating Scale, the primary efficacy measure, was found with OROS methylphenidate treatment compared with placebo. Similar findings were noted with parent- and adolescent-report measures. Based on a Clinical Global Impression improvement subscale score of much or very much improved, 52% of subjects in the OROS methylphenidate group improved compared with 31% receiving placebo. Thirty-seven percent of subjects required the maximum dosage of 72 mg/d. The incidence of drug-related adverse events was similar between the 2 study groups.
Conclusion In adolescents, once-daily OROS methylphenidate significantly reduced ADHD symptoms and was well tolerated using dosages up to 72 mg/d.
Author Affiliations: Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston (Dr Wilens); The Children’s Center at Langley Porter, University of California, San Francisco (Dr McBurnett); Neuropsychiatric Institute, University of California, Los Angeles (Dr McGough); Department of Pediatrics, University of California, Irvine (Dr Lerner); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Dr Bukstein), and McNeil Consumer & Specialty Pharmaceuticals, Fort Washington (Drs Denisco, Halstead, and Lynch and Mss Bloom, Zimmerman, Gu, and Cooper), Pa; New York State Psychiatric Institute (Dr Greenhill) and Department of Psychiatry, Mount Sinai School of Medicine (Dr Newcorn), New York; Department of Psychiatry, University of California, San Diego (Dr Stein); Duke University Medical Center, Durham (Dr Conners), and Behavioral Health Center, Charlotte (Dr Casat), NC; Children’s Hospital Medical Center of Akron, Akron (Dr Duby), and Columbus Children’s Hospital, Columbus (Dr Coury), Ohio; CNS Healthcare Orlando Research Center, Orlando, Fla (Dr Bailey); and Nebraska Medical Center, Omaha (Dr Kratochvil).
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