Stimulant treatment over five years: Adherence, effectiveness, and adverse effects
Stimulant treatment over five years: Adherence, effectiveness, and adverse effects
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DOI：
10.1097/00004583-200405000-00009
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发表时间：
2004-05-01
影响因子：
13.3
通讯作者：
Schachar, R
中科院分区：
文献类型：
--
作者：
Charach, A;Ickowicz, A;Schachar, R
目的：为了评估依从性和药物状态对5年以上注意缺陷多动障碍（ADHD）儿童使用兴奋剂的有效性和不良反应的影响，方法：在一项为期12个月的哌甲酯和父母组的随机对照试验中，91名参与者中有79名参加了随访研究。对兴奋剂的依从性、治疗反应和不良反应每年进行一次评价，持续5年。教师报告的症状和家长报告的不良反应的变化进行了比较，在2年，3年，4年和5年的3组：依从性，非依从性药物治疗，或非依从性药物治疗。控制年龄，性别和基线严重程度，依从性状态和药物治疗状态进行评估，作为教师报告的ADHD症状评分的相关性，在每年使用多元回归分析。结果如下：在2年时，依从者（n = 41）在教师报告的症状方面的改善比停止用药者（n = 16）更大，对兴奋剂的非依从者（n = 16）的反应相当（p = 0.02）。在5年时，坚持者（n = 16）表现出更大的改善教师报告的症状比非坚持兴奋剂（n = 15）和那些关闭药物（n = 14）（p = 0.04）。第2年的药物状态（β = 4.67 [0.40-8.95，p = 0.033]）和第5年的依从性状态（β = 7.23 [3.01-11.44，p = 0.001]）与教师报告的症状评分较高相关。临床显著不良反应持续5年，最常见的是食欲不振。结论：精神兴奋剂改善ADHD症状长达5年，但不良反应持续存在。
Objective: To evaluate the impact of adherence and medication status on effectiveness and adverse effects of stimulant use in children with attention-deficit/hyperactivity disorder (ADHD) over 5 years, Method: Seventy-nine of 91 participants in a 12-month randomized controlled trial of methylphenidate and parent groups enrolled in a follow-up study. Adherence to stimulants, treatment response, and adverse effects were evaluated annually for 5 years. Changes in teacher-reported symptoms and parent-reported adverse effects were compared at 2, 3, 4, and 5 years for 3 groups: adherents, nonadherents on medication, or nonadherents off medication. Controlling for age, gender, and baseline severity, adherence status and medication status were evaluated as correlates of teacher-reported ADHD symptom scores at each year using multiple regression analyses. Results: At 2 years, adherents (n = 41) showed greater improvement in teacher-reported symptoms than those off medication (n = 16) and equivalent response to nonadherents on stimulants (n = 16) (p = .02). At 5 years, adherents (n = 16) showed greater improvement in teacher-reported symptoms than nonadherents on stimulants (n = 15) and those off medication (n = 14) (p = .04). At year 2 medication status (beta = 4.67 [0.40-8.95, p = .033]) and at year 5 adherence status (beta = 7.23 [3.01-11.44, p = .001]) correlated with higher teacher-reported symptom scores. Clinically significant adverse effects were present for 5 years, most commonly loss of appetite. Conclusions: Psychostimulants improve ADHD symptoms for up to 5 years, but adverse effects persist.