Objective: The purpose of this study was to evaluate the comparative efficacy and safety of a novel long-duration multilayer-release (MLR) methylphenidate (MPH) formulation and immediate-release (IR) MPH in attention-deficit/hyperactivity disorder (ADHD) children.
Patients and Methods: This study was a randomized, double-blind, crossover comparison of once-daily MLR and twice-daily IR-MPH in home and school settings in children with a Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnosis of ADHD. Patients completed a 1-week baseline followed by two active medication titration phases. Each phase of treatment was 1–4 weeks of titration with an additional stable dose week. The final dose was based on efficacy and adverse events for each patient. Efficacy measures included Clinical Global Impressions (CGI) and Conners' Parent and Teacher Rating Scales (CPRS and CTRS). The Clinical Assessment of Side Effects (CASE) scale assessed frequency of adverse events.
Results: Of the 90 enrolled patients, aged 6.4–17.5 years, 79 (88%) completed the study. Stable daily doses were 32.0 and 32.5 mg for MLR- and IR-MPH, respectively. All efficacy parameters were significantly improved from baseline. A total of 73.2% and 81.0% of patients on MLR- and IR-MPH were rated as “much” or “very much improved” on the CGI. A total of 77.4% and 81.1% of patients were normalized on the CPRS-R and 78.9 and 90.4% of patients were normalized on the CTRS-R for MLR- and IR-MPH, respectively. The mean CASE score was not different from baseline for either treatment.
Conclusions: In treatment of ADHD, once-daily MLR-MPH produces significant improvements in situational behavior similar to IR-MPH with a favorable side effect profile and a prolonged duration of effect.
