Update on optimal use of lisdexamfetamine in the treatment of ADHD

Madaan, Vishal; Kolli, Venkata; Bestha, Durga Prasad; Shah, Manan J

doi:10.2147/ndt.s34092

Cited by 12 publications

(14 citation statements)

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“…Like other stimulants, dextroamphetamine blocks the reuptake of norepinephrine and dopamine into the presynaptic neuron and directly increases the release of these monoamines extraneuronally. 9 …”

Section: Discussionmentioning

confidence: 99%

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Comparative efficacy, acceptability, and tolerability of lisdexamfetamine in child and adolescent ADHD: a meta-analysis of randomized, controlled trials

Maneeton¹,

Maneeton²,

Likhitsathian³

et al. 2015

DDDT

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BackgroundSeveral studies have shown that lisdexamfetamine (LDX) is efficacious in children and adolescents with attention-deficit/hyperactivity disorder (ADHD).ObjectivesAims of this study were to systematically review the efficacy, acceptability, and tolerability of LDX in child and adolescent ADHD. Any randomized controlled trials (RCTs) of LDX versus placebo carried out in children and adolescents with ADHD were included.Data sourcesThe searches of the SCOPUS, MEDLINE, CINAHL and Cochrane Controlled Trials Register were performed in September 2014. Additional searches in the ClinicalTrials. gov and EU Clinical Trials Register database were conducted.Study eligibility criteria, participants, and interventionsThis review included all RCTs of LDX versus placebo which were carried out in children and adolescents up to 18 years old. Additionally, the included studies must have reported the final outcomes of: i) severity of ADHD symptoms with standardized scales, ii) rates of improvement, iii) rates of discontinuation. To be more thorough, the languages of such RCTs were not limited.Study appraisal and synthesis methodsThe abstracts from databases were inspected and the full text versions of relevant trials were examined and extracted for important outcomes. The efficacious measurements included either the pooled mean end-point or changed scores of ADHD rating scales, and the rate of improvement. Acceptability and tolerability were measured by the pooled overall discontinuation rate and the pooled discontinuation rate due to adverse events, respectively. A random effect model technique was utilized to synthesize the mean differences (either standardized mean differences or weighted mean differences) and relative risks (RRs) with 95% confidence intervals (CIs).ResultsA total of 1,016 children and adolescents with ADHD were included. The dosage of LDX was 30 to 70 mg/day. The pooled mean change scores of LDX-treated group was significantly greater than that of the placebo (weighted mean difference [95% CI] of −15.20 [−19.95, −10.46], I2=94%). The pooled improvement rate of the LDX-treated group was also significantly higher than that of the placebo (RR [95% CI] of 0.34 [0.24, 0.47], I2=80%). The pooled overall discontinuation rate between the two groups was not significantly different (RR [95% CI] of 0.78 [0.46, 1.31], I2=63%). Similarly, the pooled discontinuation rate due to adverse events between the two groups showed no significant difference (RR [95% CI] of 1.99 [0.70, 5.64], I2=0%).LimitationsThe number of included studies was limited (five RCTs).ConclusionAccording to the present review, LDX was effective and well-tolerated in the treatment of child and adolescent ADHD. Unfortunately, the acceptability of LDX was not better than the placebo. Since the number of included studies was limited, the outcome from this review should be carefully interpreted and considered as preliminary. Further studies, therefore, should be conducted to confirm these findings.Implication of key findingsLisdexamfetamine is an efficac...

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Section: Discussionmentioning

confidence: 99%

“… 7 Since LDX requires an enzyme in red blood cells to be converted to the active form of amphetamine, it tends to have less potential for drug abuse and diversion, and has a relatively long-acting property. 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy, acceptability, and tolerability of lisdexamfetamine in child and adolescent ADHD: a meta-analysis of randomized, controlled trials

Maneeton¹,

Maneeton²,

Likhitsathian³

et al. 2015

DDDT

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“…The efficacy of LDX in adult ADHD may be explained by its metabolite, dextroamphetamine, which blocks the reuptake of norepinephrine and dopamine into the presynaptic neuron and directly increases the release of these monoamines extraneuronally, similar to other psychostimulants. 15 …”

Section: Discussionmentioning

confidence: 99%

“… 13 As a prodrug, LDX needs an enzyme in red blood cells to convert to the active form of amphetamine; therefore, it has less potential for abuse and diversion, and longer effect, as compared with other stimulants. 14 , 15 …”

Section: Introductionmentioning

confidence: 99%

Exploratory meta-analysis on lisdexamfetamine versus placebo in adult ADHD

Maneeton¹,

Maneeton²,

Suttajit³

et al. 2014

DDDT

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BackgroundRecent studies have promised that lisdexamfetamine (LDX) is effective in the treatment of adults with attention-deficit hyperactivity disorder (ADHD).ObjectivesThis systematic review was undertaken to summarize LDX efficacy, acceptability, and tolerability in adult ADHD. All randomized controlled trials (RCTs) of lisdexamfetamine compared with placebo were included for synthesis. Clinical trials published between January 1991 and January 2014 were evaluated.MethodsThe database of MEDLINE®, EMBASE™, CINAHL®, PsycINFO® and Cochrane Controlled Trials Register were searched in January 2014. Studies were also searched in ClinicalTrials.gov and the EU Clinical Trials Register database. Study eligibility criteria, participants, and interventions were considered. All RCTs of LDX vs placebo reporting final results of: 1) severity of ADHD symptoms and executive function deficit, 2) response or remission rates, 3) overall discontinuation rate, or 4) discontinuation rate due to adverse events were included. The language of the papers was not restricted. All abstracts of studies gathered from the database were examined. After excluding irrelevant trials, the full text version of relevant studies were assessed and extracted for outcomes of interest. Examination of risks of bias, based on the Cochrane bias assessment, was carried out. The efficacy outcomes consisted of the mean end point or change scores for ADHD rating scales, the response rate, and the remission rate. The overall discontinuation rate and the discontinuation rate due to adverse events were measured for acceptability and tolerability, respectively. A random effect model was applied for the synthesis of relative risks (RRs), and weighted mean differences or standardized mean differences (SMDs) with 95% confidence intervals (CIs).ResultsA total of 806 final study or safety participants were included. The dosage of lisdexamfetamine was 30 to 70 mg/day. The pooled mean scores of mean change and mean end point scores between LDX- and placebo-treated groups also had a significant difference (SMD [95% CI] of −0.97 [−1.15, −0.78], I2=18%). The pooled response rates for adult ADHD between the two groups had a significant difference (RR [95% CI] of 1.99 [1.50, 2.63], I2=0%). Based on the Behavior Rating Inventory of Executive Function – Adult version (BRIEF-A), the pooled end point mean scores for the Global Executive Composite (GEC) for the LDX-treated groups was greater than that of placebo-treated groups (MD [95% CI] of −9.20 [−14.11, −4.29], I2=34%). The pooled overall discontinuation rates between the two groups had no significant difference (RR [95% CI] of 0.82 [0.59, 1.14], I2=0%). Similarly, the pooled discontinuation rates due to adverse events between the two groups was not significantly different (RR [95% CI] of 1.77 [0.71, 4.40], I2=0%).ConclusionThe number of included studies was limited (five RCTs), but based on this meta-analysis, LDX is efficacious and well tolerated in the treatment of adult ADHD. Additionally, it also improved the executive fu...

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“…La importancia de analizar esta interacción radicaría en dos aspectos, primero, el tener mayor claridad de un modelo explicativo del TDAH, comprendido como un trastorno del neurodesarrollo del funcionamiento ejecutivo, y en segundo lugar, el beneficio que esta población infantil podría obtener, principalmente en procesos terapéuticos basados en el funcionamiento ejecutivo (Cantwell, 1996;Valverde & Inchauspe, 2014;Madaan, Kolli, Bestha & Shah, 2013).…”

Section: Conclusionesunclassified

Control inhibitorio, monitorización y habla autodirigida en el Trastorno por Déficit de Atención con Hiperactividad

Ramos

Pérez-Salas

Lepe

2016

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Resumen: El trastorno por déficit de atención con hiperactividad (TDAH) es un trastorno del neurodesarrollo que afecta aproximadamente entre el 3% y 10% de la población infantil. En lo empírico y teórico se ha descrito que las alteraciones en el control inhibitorio, monitorización y habla autodirigida serían aspectos cognitivos deficitarios en este cuadro clínico. En el presente artículo realizamos una revisión de artículos indexados en las principales bases de datos que reportan estudios empíricos y propuestas teóricas sobre el control inhibitorio, monitorización y el habla autodirigida en población con trastorno por déficit de atención con hiperactividad. Como conclusión se afirma que las funciones ejecutivas descritas podrían componer modelos explicativos de la sintomatología del TDAH en donde se presente una interacción entre las mismas, lo cual aportaría en la comprensión de este trastorno y en su tratamiento.Palabras clave: trastorno por déficit de atención con hiperactividad, monitorización, control inhibitorio, habla autodirigida, función ejecutiva. Control inhibitorio Abstract:ADHD is a neurodevelopmental disorder that affects approximately 3% to 10% of the child population. Theory and research in this field have described that alterations in the inhibitory control, monitoring and self-directed speech are the most deficient cognitive aspects in clinical cases like these. In this article we review the conceptualization of ADHD clinical perspective of this disorder, gender differences and describe the major deficits of executive function present in this disorder. In this article we review articles indexed in major databases that report empirical and theoretical proposals on inhibitory control, monitoring and self-directed population speaks attention deficit disorder with hyperactivity. In conclusion states that executive functions described could compose explanatory models of ADHD symptomatology where an interaction between them, which would contribute to the understanding of this disorder and its treatment is present.

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Update on optimal use of lisdexamfetamine in the treatment of ADHD

Cited by 12 publications

References 44 publications

Comparative efficacy, acceptability, and tolerability of lisdexamfetamine in child and adolescent ADHD: a meta-analysis of randomized, controlled trials

Comparative efficacy, acceptability, and tolerability of lisdexamfetamine in child and adolescent ADHD: a meta-analysis of randomized, controlled trials

Exploratory meta-analysis on lisdexamfetamine versus placebo in adult ADHD

Control inhibitorio, monitorización y habla autodirigida en el Trastorno por Déficit de Atención con Hiperactividad

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