PDF(Pubmed)
Abstract：
Objectives: This study aimed to examine switch from first-line methylphenidate (MPH) to lisdexamfetamine (LDX) in school-aged children with attention-deficit/hyperactivity disorder (ADHD). Methods: This is a retrospective observational study based on systematic review of patient records of all children (7-13 years) diagnosed with ADHD and referred to a Danish specialized outpatient clinic. The study included 394 children switching from MPH to LDX as either second-line or third-line treatment (atomoxetine [ATX] as second-line treatment) during the study period from April 1, 2013, to November 5, 2019. Results: One in five children switched from MPH to LDX at some point during the study period. The most frequent reasons for switching to LDX were adverse effects (AEs; 70.0% for MPH, 68.3% for ATX) and lack of efficiency (52.0% for MPH, 72.7% for ATX). Top five AEs of LDX were decreased appetite (62.4%), insomnia (28.7%), irritability/aggression (26.1%), weight decrease (21.1%), and mood swings (13.9%). MPH and LDX had similar AE profiles, yet most AEs were less frequent after switching to LDX. At the end of the study period, the majority were prescribed LDX as second-line rather than third-line treatment (86.1% in 2019). However, the likelihood of LDX as second-line treatment decreased with the number of psychiatric comorbidities, ADHD symptom severity as assessed by parents, and if AEs were a reason for MPH discontinuation. Among children observed for at least 1 year after initiation of LDX, 41.3% continued LDX treatment for a year or longer. LDX continuation was less likely if AEs were a reason for MPH discontinuation. Similarly to MPH and ATX, the most frequent reasons for LDX discontinuation were AEs (74.4%) and lack of efficiency (34.7%). Implications: The findings support LDX as an important option in the personalized treatment of children with ADHD and may support prescribers in the clinical decision-making on switching medication.
摘要：
目标：本研究旨在研究患有注意力缺陷/多动障碍（ADHD）的学龄儿童从一线哌醋甲酯（MPH）到右氨非他明（LDX）的转换。方法：这是一项回顾性观察性研究，基于对所有诊断为ADHD并转诊至丹麦专科门诊的儿童（7-13岁）的患者记录的系统回顾。该研究包括2013年4月1日至2019年11月5日的研究期间，394名儿童从MPH转为LDX作为二线或三线治疗（阿托西汀[ATX]作为二线治疗）。结果：五分之一的儿童在研究期间的某个时间点从MPH转换为LDX。切换到LDX的最常见原因是不良反应(AEs；MPH为70.0%，ATX为68.3％）和缺乏效率（MPH为52.0％，ATX的72.7%)。LDX的前五个不良事件是食欲下降（62.4%），失眠（28.7%），易怒/攻击性（26.1%），体重减轻（21.1%），和情绪波动（13.9%）。MPH和LDX具有相似的AE谱，然而,大多数AE在切换至LDX后的频率较低.在研究期结束时，大多数患者被处方LDX作为二线而不是三线治疗（2019年为86.1%）。然而,LDX作为二线治疗的可能性随着精神病合并症的数量而降低，父母评估的ADHD症状严重程度，以及AEs是否是MPH停药的原因。在开始LDX后至少1年观察的儿童中，41.3%的人继续LDX治疗一年或更长时间。如果AE是MPH停药的原因，则LDX继续的可能性较小。与MPH和ATX类似，LDX停药最常见的原因是AEs(74.4%)和无效率(34.7%).含义：研究结果支持LDX作为ADHD儿童个性化治疗的重要选择，并可能支持处方者在切换药物的临床决策中。
