Methylphenidate dosage for children with ADHD over time under controlled conditions: Lessons from the MTA
Methylphenidate dosage for children with ADHD over time under controlled conditions: Lessons from the MTA
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DOI：
10.1097/00004583-200102000-00013
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发表时间：
2001-02-01
影响因子：
13.3
通讯作者：
Cantwell, DP
中科院分区：
文献类型：
--
作者：
Vitiello, B;Severe, JB;Cantwell, DP
检查哌醋甲酯 (MPH) 剂量随时间的变化轨迹。进行受控滴定后，并确定滴定能够如何准确地预测患有注意力缺陷/多动症（ADHD）儿童的有效长期治疗。方法：使用 NIMH 儿童注意力缺陷/多动障碍 (MTA) 协作多部位多模式治疗研究的 14 个月治疗数据库，将初始安慰剂对照、双盲、随机每日切换 MPH 滴定的结果与随后的维持药物治疗进行比较。儿童每月接受一次监测，并在需要时进行药物调整。结果：在滴定时 MPH 是最佳治疗的 198 名儿童中（平均 +/- SD 剂量：30.5 +/- 14.2 毫克/天），88% 的儿童在维持结束时仍在服用 MPH（平均剂量 34.4 +/- 13.3 毫克/天）。滴定确定的剂量和维持结束剂量显着相关（r = 0.52-0.68）。接受联合药物治疗和行为治疗的儿童结束维持剂量（31.1 +/- 11.7 毫克/天）比仅接受药物治疗的儿童（38.1 +/- 14.2 毫克/天）低。在 230 名儿童中，滴定法确定了最佳治疗方法。 17% 的人在整个维持期间继续服用指定的药物和剂量。每个儿童的平均药理学变化次数为 2.8 +/- 1.8 (SD)，首次变化的时间为 4.7 个月 +/- 0.3 (SE)。结论：对于大多数儿童来说，初始滴定发现 MPH 剂量在有效维持剂量的一般范围内，但并没有阻止后续维持调整的需要。为了获得 ADHD 的最佳药物治疗，需要仔细的初始滴定和持续的药物管理。
To examine the trajectory of methylphenidate (MPH) dosage over time. following a controlled titration, and to ascertain how accurately the titration was able to predict effective long-term treatment in children with attention-deficit/hyperactivity disorder (ADHD). Method: Using the 14-month-treatment database of the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA), the outcome of the initial placebo-controlled, double-blind, randomized daily switch titration of MPH was compared with the subsequent maintenance pharmacotherapy. Children received monthly monitoring visits and, when needed, medication adjustments. Results: Of the 198 children for whom MPH was the optimal treatment at titration (mean +/- SD dose: 30.5 +/- 14.2 mg/day), 88% were still taking MPH at the end of maintenance (mean dose 34.4 +/- 13.3 mg/day). Titration-determined dose and end-of-maintenance dose were significantly correlated (r = 0.52-0.68). Children receiving combined pharmacotherapy and behavioral treatment ended maintenance on a lower dose (31.1 +/- 11.7 mg/day) than did children receiving pharmacotherapy only (38.1 +/- 14.2 mg/day). Of the 230 children for whom titration identified an optimal treatment. 17% continued both the assigned medication and dosage throughout maintenance. The mean number of pharmacological changes per child was 2.8 +/- 1.8 (SD), and time to first change was 4.7 months +/- 0.3 (SE). Conclusions: Far most children, initial titration found a dose of MPH in the general range of the effective maintenance dose, but did not prevent the need for subsequent maintenance adjustments. For optimal pharmacological treatment of ADHD, both careful initial titration and ongoing medication management are needed.