Switch in Therapy from Methylphenidate to Atomoxetine in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: An Analysis of Patient Records

Pernille Warrer; Per Hove Thomsen; Søren Dalsgaard; Ebba Holme Hansen; Lise Aagaard; Helle Wallach Kildemoes; Henrik Berg Rasmussen

doi:10.1089/cap.2015.0060

Switch in Therapy from Methylphenidate to Atomoxetine in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: An Analysis of Patient Records

Pernille Warrer, Per Hove Thomsen, Søren Dalsgaard, Ebba Holme Hansen, Lise Aagaard, Helle Wallach Kildemoes, Henrik Berg Rasmussen

4 Citations (Scopus)

Abstract

OBJECTIVE: The purpose of this study was to investigate therapy switching from methylphenidate (MPH) to atomoxetine (ATX) in a clinical sample of Danish children and adolescents with attention-deficit/hyperactivity disorder (ADHD); specifically, to determine the duration of MPH treatment before switching to ATX, and the reasons leading to a switch in therapy.

METHODS: We included 55 patients with ADHD who switched from first-line MPH to second-line ATX during January 01, 2012 and May 15, 2014. Patient and treatment characteristics along with clinical reasons for switching therapy were extracted from individual patients' records.

RESULTS: Mean duration of MPH treatment until switch to ATX was 11.2 months (range = 0.3-28.5 months); 36% of the patients switched within the first 6 months, 56% within the first year, and 76% within 1.5 years of initiating MPH; 24% continued MPH treatment for up to 2.5 years prior to switching. Most common reasons for switching were "adverse events" (AEs) (78%), "wish for more optimal day coverage" (24%), and "lack of efficacy" (16%). Other reasons for switching included "patient/parental request" (13%) and "noncompliance" (2%). Most common AEs leading to switch were psychiatric disorders (insomnia, aggression, tic, depression, anxiety) and decreased appetite.

CONCLUSIONS: Our findings highlight the importance of continuous evaluation of the need for prescription switch to ATX in children and adolescents treated with MPH, taking into consideration various factors including potential AEs, non-optimal day coverage, lack of efficacy, patient/parental preferences, and noncompliance. These factors should be considered, not only at the initial stage of MPH treatment but throughout the whole treatment course.

Original language	English
Journal	Journal of Child and Adolescent Psychopharmacology
Volume	26
Issue number	4
Pages (from-to)	354-361
Number of pages	8
ISSN	1044-5463
DOIs	https://doi.org/10.1089/cap.2015.0060
Publication status	Published - 1 May 2016

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10.1089/cap.2015.0060

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Warrer, P., Thomsen, P. H., Dalsgaard, S., Hansen, E. H., Aagaard, L., Wallach Kildemoes, H., & Rasmussen, H. B. (2016). Switch in Therapy from Methylphenidate to Atomoxetine in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: An Analysis of Patient Records. Journal of Child and Adolescent Psychopharmacology, 26(4), 354-361. https://doi.org/10.1089/cap.2015.0060

Switch in Therapy from Methylphenidate to Atomoxetine in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: An Analysis of Patient Records. / Warrer, Pernille; Thomsen, Per Hove; Dalsgaard, Søren et al.
In: Journal of Child and Adolescent Psychopharmacology, Vol. 26, No. 4, 01.05.2016, p. 354-361.

Research output: Contribution to journal › Journal article › Research › peer-review

Warrer, P, Thomsen, PH, Dalsgaard, S, Hansen, EH, Aagaard, L, Wallach Kildemoes, H & Rasmussen, HB 2016, 'Switch in Therapy from Methylphenidate to Atomoxetine in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: An Analysis of Patient Records', Journal of Child and Adolescent Psychopharmacology, vol. 26, no. 4, pp. 354-361. https://doi.org/10.1089/cap.2015.0060

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title = "Switch in Therapy from Methylphenidate to Atomoxetine in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: An Analysis of Patient Records",

abstract = "OBJECTIVE: The purpose of this study was to investigate therapy switching from methylphenidate (MPH) to atomoxetine (ATX) in a clinical sample of Danish children and adolescents with attention-deficit/hyperactivity disorder (ADHD); specifically, to determine the duration of MPH treatment before switching to ATX, and the reasons leading to a switch in therapy.METHODS: We included 55 patients with ADHD who switched from first-line MPH to second-line ATX during January 01, 2012 and May 15, 2014. Patient and treatment characteristics along with clinical reasons for switching therapy were extracted from individual patients' records.RESULTS: Mean duration of MPH treatment until switch to ATX was 11.2 months (range = 0.3-28.5 months); 36% of the patients switched within the first 6 months, 56% within the first year, and 76% within 1.5 years of initiating MPH; 24% continued MPH treatment for up to 2.5 years prior to switching. Most common reasons for switching were {"}adverse events{"} (AEs) (78%), {"}wish for more optimal day coverage{"} (24%), and {"}lack of efficacy{"} (16%). Other reasons for switching included {"}patient/parental request{"} (13%) and {"}noncompliance{"} (2%). Most common AEs leading to switch were psychiatric disorders (insomnia, aggression, tic, depression, anxiety) and decreased appetite.CONCLUSIONS: Our findings highlight the importance of continuous evaluation of the need for prescription switch to ATX in children and adolescents treated with MPH, taking into consideration various factors including potential AEs, non-optimal day coverage, lack of efficacy, patient/parental preferences, and noncompliance. These factors should be considered, not only at the initial stage of MPH treatment but throughout the whole treatment course.",

author = "Pernille Warrer and Thomsen, {Per Hove} and S{\o}ren Dalsgaard and Hansen, {Ebba Holme} and Lise Aagaard and {Wallach Kildemoes}, Helle and Rasmussen, {Henrik Berg}",

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doi = "10.1089/cap.2015.0060",

language = "English",

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T1 - Switch in Therapy from Methylphenidate to Atomoxetine in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

T2 - An Analysis of Patient Records

AU - Warrer, Pernille

AU - Thomsen, Per Hove

AU - Dalsgaard, Søren

AU - Hansen, Ebba Holme

AU - Aagaard, Lise

AU - Wallach Kildemoes, Helle

AU - Rasmussen, Henrik Berg

PY - 2016/5/1

Y1 - 2016/5/1

N2 - OBJECTIVE: The purpose of this study was to investigate therapy switching from methylphenidate (MPH) to atomoxetine (ATX) in a clinical sample of Danish children and adolescents with attention-deficit/hyperactivity disorder (ADHD); specifically, to determine the duration of MPH treatment before switching to ATX, and the reasons leading to a switch in therapy.METHODS: We included 55 patients with ADHD who switched from first-line MPH to second-line ATX during January 01, 2012 and May 15, 2014. Patient and treatment characteristics along with clinical reasons for switching therapy were extracted from individual patients' records.RESULTS: Mean duration of MPH treatment until switch to ATX was 11.2 months (range = 0.3-28.5 months); 36% of the patients switched within the first 6 months, 56% within the first year, and 76% within 1.5 years of initiating MPH; 24% continued MPH treatment for up to 2.5 years prior to switching. Most common reasons for switching were "adverse events" (AEs) (78%), "wish for more optimal day coverage" (24%), and "lack of efficacy" (16%). Other reasons for switching included "patient/parental request" (13%) and "noncompliance" (2%). Most common AEs leading to switch were psychiatric disorders (insomnia, aggression, tic, depression, anxiety) and decreased appetite.CONCLUSIONS: Our findings highlight the importance of continuous evaluation of the need for prescription switch to ATX in children and adolescents treated with MPH, taking into consideration various factors including potential AEs, non-optimal day coverage, lack of efficacy, patient/parental preferences, and noncompliance. These factors should be considered, not only at the initial stage of MPH treatment but throughout the whole treatment course.

AB - OBJECTIVE: The purpose of this study was to investigate therapy switching from methylphenidate (MPH) to atomoxetine (ATX) in a clinical sample of Danish children and adolescents with attention-deficit/hyperactivity disorder (ADHD); specifically, to determine the duration of MPH treatment before switching to ATX, and the reasons leading to a switch in therapy.METHODS: We included 55 patients with ADHD who switched from first-line MPH to second-line ATX during January 01, 2012 and May 15, 2014. Patient and treatment characteristics along with clinical reasons for switching therapy were extracted from individual patients' records.RESULTS: Mean duration of MPH treatment until switch to ATX was 11.2 months (range = 0.3-28.5 months); 36% of the patients switched within the first 6 months, 56% within the first year, and 76% within 1.5 years of initiating MPH; 24% continued MPH treatment for up to 2.5 years prior to switching. Most common reasons for switching were "adverse events" (AEs) (78%), "wish for more optimal day coverage" (24%), and "lack of efficacy" (16%). Other reasons for switching included "patient/parental request" (13%) and "noncompliance" (2%). Most common AEs leading to switch were psychiatric disorders (insomnia, aggression, tic, depression, anxiety) and decreased appetite.CONCLUSIONS: Our findings highlight the importance of continuous evaluation of the need for prescription switch to ATX in children and adolescents treated with MPH, taking into consideration various factors including potential AEs, non-optimal day coverage, lack of efficacy, patient/parental preferences, and noncompliance. These factors should be considered, not only at the initial stage of MPH treatment but throughout the whole treatment course.

U2 - 10.1089/cap.2015.0060

DO - 10.1089/cap.2015.0060

M3 - Journal article

C2 - 26891424

SN - 1044-5463

VL - 26

SP - 354

EP - 361

JO - Journal of Child and Adolescent Psychopharmacology

JF - Journal of Child and Adolescent Psychopharmacology

IS - 4

ER -

Switch in Therapy from Methylphenidate to Atomoxetine in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: An Analysis of Patient Records

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