注意缺陷/多动障碍患者对刺激剂的单剂量临床反应与长期临床反应之间的关系:随机对照试验的系统回顾。

IF 1.5 4区 医学 Q2 PEDIATRICS
Valeria Parlatini, Alessio Bellato, Sulagna Roy, Declan Murphy, Samuele Cortese
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引用次数: 0

摘要

目的:哌醋甲酯(MPH)和苯丙胺等兴奋剂是治疗注意力缺陷/多动障碍(ADHD)的一线药物选择。随机对照试验(RCTs)在群体水平上证明了其有益效果,但无法确定与不同个体反应相关的一致特征。因此,需要更多个性化的方法。实验研究表明,对单次剂量的神经生物学反应表明了较长期的反应。目前还不清楚这是否也适用于临床测量。方法:我们对测试单剂量兴奋剂临床反应与长期改善之间关系的研究性临床试验进行了系统回顾。从MED-ADHD数据集、欧洲ADHD指南组RCT数据集(https://med-adhd.org/)(于2024年2月1日更新)中确定了可能合适的单剂量RCT。使用 Cochrane 偏倚风险 (RoB) 2.0 工具进行了质量评估。结果共发现 63 项单剂量 RCT(94% 测试 MPH,85% 用于儿童)。其中,只有一项 RCT 的二次分析检验了急性和长期临床反应之间的关联。结果表明,在 46 名患有多动症的儿童(89% 为男性)中,单剂量 MPH 治疗后的临床改善与 4 周 MPH 治疗后的症状改善显著相关。偏倚风险被评为中度。还有一项研究使用了近红外光谱,因此不符合纳入标准,该研究报告了22名ADHD儿童(82%为男性)在单剂量治疗后大脑变化与长期临床反应之间的关系。其余的研究只报告了单剂量对神经心理学、神经影像学或神经生理学测量的影响。结论本系统综述强调了当前知识中的一个重要空白。研究急性反应和长期反应之间的关系可以促进我们对兴奋剂作用机制的了解,并有助于开发分层方法,制定更有针对性的治疗策略。未来的研究需要调查潜在的年龄和性别差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association Between Single-Dose and Longer Term Clinical Response to Stimulants in Attention-Deficit/Hyperactivity Disorder: A Systematic Review of Randomized Controlled Trials.

Objectives: Stimulants, such as methylphenidate (MPH) and amphetamines, represent the first-line pharmacological option for attention-deficit/hyperactivity disorder (ADHD). Randomized controlled trials (RCTs) have demonstrated beneficial effects at a group level but could not identify characteristics consistently associated with varying individual response. Thus, more individualized approaches are needed. Experimental studies have suggested that the neurobiological response to a single dose is indicative of longer term response. It is unclear whether this also applies to clinical measures. Methods: We carried out a systematic review of RCTs testing the association between the clinical response to a single dose of stimulants and longer term improvement. Potentially suitable single-dose RCTs were identified from the MED-ADHD data set, the European ADHD Guidelines Group RCT Data set (https://med-adhd.org/), as updated on February 1, 2024. Quality assessment was carried out using the Cochrane Risk of Bias (RoB) 2.0 tool. Results: A total of 63 single-dose RCTs (94% testing MPH, 85% in children) were identified. Among these, only a secondary analysis of an RCT tested the association between acute and longer term clinical response. This showed that the clinical improvement after a single dose of MPH was significantly associated with symptom improvement after a 4-week MPH treatment in 46 children (89% males) with ADHD. The risk of bias was rated as moderate. A further RCT used near-infrared spectroscopy, thus did not meet the inclusion criteria, and reported an association between brain changes under a single-dose and longer term clinical response in 22 children (82% males) with ADHD. The remaining RCTs only reported single-dose effects on neuropsychological, neuroimaging, or neurophysiological measures. Conclusion: This systematic review highlighted an important gap in the current knowledge. Investigating how acute and long-term response may be related can foster our understanding of stimulant mechanism of action and help develop stratification approaches for more tailored treatment strategies. Future studies need to investigate potential age- and sex-related differences.

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来源期刊
CiteScore
3.60
自引率
5.30%
发文量
61
审稿时长
>12 weeks
期刊介绍: Journal of Child and Adolescent Psychopharmacology (JCAP) is the premier peer-reviewed journal covering the clinical aspects of treating this patient population with psychotropic medications including side effects and interactions, standard doses, and research on new and existing medications. The Journal includes information on related areas of medical sciences such as advances in developmental pharmacokinetics, developmental neuroscience, metabolism, nutrition, molecular genetics, and more. Journal of Child and Adolescent Psychopharmacology coverage includes: New drugs and treatment strategies including the use of psycho-stimulants, selective serotonin reuptake inhibitors, mood stabilizers, and atypical antipsychotics New developments in the diagnosis and treatment of ADHD, anxiety disorders, schizophrenia, autism spectrum disorders, bipolar disorder, eating disorders, along with other disorders Reports of common and rare Treatment Emergent Adverse Events (TEAEs) including: hyperprolactinemia, galactorrhea, weight gain/loss, metabolic syndrome, dyslipidemia, switching phenomena, sudden death, and the potential increase of suicide. Outcomes research.
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