TY - JOUR
T1 - Sequential pharmacotherapy for children with comorbid attention-deficit/ hyperactivity and anxiety disorders
AU - Abikoff, Howard
AU - McGough, James
AU - Vitiello, Benedetto
AU - McCracken, James
AU - Davies, Mark
AU - Walkup, John
AU - Riddle, Mark
AU - Oatis, Melvin
AU - Greenhill, Laurence
AU - Skrobala, Anne
AU - March, John
AU - Gammon, Pat
AU - Robinson, James
AU - Lazell, Robert
AU - McMahon, Donald J.
AU - Ritz, Louise
N1 - Funding Information:
The RUPP (Research Units of Pediatric Psychopharmacology) ADHD/Anxiety Study is a multisite clinical trial supported by contracts from the National Institute of Mental Health to Johns Hopkins University (N01MH60016: P.I. Mark Riddle, M.D.), the Research Foundation for Mental Hygiene (N01MH60005: P.I. Laurence Greenhill, M.D.), and the University of California Los Angeles (K23MH01966: P.I. James McGough, M.D., N01MH70010 and MH01805: P.I. James McCracken, M.D.). The authors are indebted to Solvay Pharmaceuticals for supplying study drug and to the NIMH Data Safety and Monitoring Board.
Funding Information:
Disclosure: Dr. Abikoff has received support from McNeil (research support, consulting fees), Shire (research support, consulting fees), Eli Lilly (research support), and Celltech (consulting fees). Dr. McGough has received support from Eli Lilly (grant/research support, consulting fees, speaker's bureau), McNeil (grant/research support, consulting fees, speaker's bureau), Novartis (grant/research support, consulting fees, speaker's bureau), Shire (grant/research support, consulting fees, speaker's bureau), and Pfizer (consulting fees). Dr. McCracken has received support from Eli Lilly (research support, consulting fees, speaker fees), Shire (research support, speaker fees), Pfizer (research support, consulting fees), Solvay (research support), Gliatech (research support), Bristol-Myers Squibb (consulting fees), McNeil (consulting fees), Noven (consulting fees), and Janssen (consulting fees). Dr. Walkup has received support from Abbott (grant support), Pfizer (grant support, honoraria), Janssen (honoraria), and Lilly (grant support, honoraria, consulting fees). Dr. Riddle has received support from Forest (speaker fees), Janssen (speaker fees, scientific advisor), Lilly (consulting fees), Pfizer (research support, consulting fees), Sanofi (consulting fees), AstraZeneca (scientific advisor), Shire (scientific advisor), Mallinckrodt, and Bristol-Myers Squibb (consulting fees). Dr. Oatis has received support (consulting fees and speaker fees) from Lilly, McNeil, and Shire. Dr. Greenhill has received support (honoraria or grants to do research) from Celltech, Shire, Lilly, McNeil, Alza, Janssen-Cilag, and Novartis. Dr. March has received support from Pfizer (consulting fees, speaker fees, scientific advisor), Solvay (speaker fee, consulting fee), Wyeth (research support, consulting fees), Shire (scientific advisor), and GSK (consulting fee). The other authors have no financial relationships to disclose.
PY - 2005/5
Y1 - 2005/5
N2 - Objective: Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by clinically significant anxiety, but few empirical data guide treatment of children meeting full DSM-IV criteria for ADHD and anxiety disorders (ADHD/ANX). This study examined the efficacy of sequential pharmacotherapy for ADHD/ANX children. Method: Children, age 6 to 17 years, with ADHD/ANX were titrated to optimal methylphenidate dose and assessed along with children who entered the study on a previously optimized stimulant. Children with improved ADHD who remained anxious were randomly assigned to 8 weeks of double-blind stimulant + fluvoxamine (STIM/FLV) or stimulant + placebo (STIM/PL). Primary efficacy measures were the Swanson, Nolan, Atkins, and Pelham IV Parent and Teacher Rating Scale ADHD score and the Pediatric Anxiety Rating Scale total score. ADHD, ANX, and overall Clinical Global Impressions- Improvement scores were also obtained. Results: Of the 32 medication-naïve children openly treated with methylphenidate, 26 (81%) improved as to ADHD. Twenty-five children entered the randomized trial. Intent-to-treat analysis indicated no differences between the STIM/FLV (n = 15) and STIM/PL groups on the Pediatric Anxiety Rating Scale or Clinical Global impressions-improvement- defined responder rate. Medications in both arms were well tolerated. Conclusions: Children with ADHD/ANX have a response rate to stimulants for ADHD that is comparable with that of children with general ADHD. The benefit of adding FLV to stimulants for ANX remains unproven.
AB - Objective: Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by clinically significant anxiety, but few empirical data guide treatment of children meeting full DSM-IV criteria for ADHD and anxiety disorders (ADHD/ANX). This study examined the efficacy of sequential pharmacotherapy for ADHD/ANX children. Method: Children, age 6 to 17 years, with ADHD/ANX were titrated to optimal methylphenidate dose and assessed along with children who entered the study on a previously optimized stimulant. Children with improved ADHD who remained anxious were randomly assigned to 8 weeks of double-blind stimulant + fluvoxamine (STIM/FLV) or stimulant + placebo (STIM/PL). Primary efficacy measures were the Swanson, Nolan, Atkins, and Pelham IV Parent and Teacher Rating Scale ADHD score and the Pediatric Anxiety Rating Scale total score. ADHD, ANX, and overall Clinical Global Impressions- Improvement scores were also obtained. Results: Of the 32 medication-naïve children openly treated with methylphenidate, 26 (81%) improved as to ADHD. Twenty-five children entered the randomized trial. Intent-to-treat analysis indicated no differences between the STIM/FLV (n = 15) and STIM/PL groups on the Pediatric Anxiety Rating Scale or Clinical Global impressions-improvement- defined responder rate. Medications in both arms were well tolerated. Conclusions: Children with ADHD/ANX have a response rate to stimulants for ADHD that is comparable with that of children with general ADHD. The benefit of adding FLV to stimulants for ANX remains unproven.
KW - Anxiety
KW - Attention-deficit/hyperactivity
KW - Combination pharmacotherapy
KW - Comorbidity
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U2 - 10.1097/01.chi.0000155320.52322.37
DO - 10.1097/01.chi.0000155320.52322.37
M3 - Article
C2 - 15843763
AN - SCOPUS:20944443402
SN - 0890-8567
VL - 44
SP - 418
EP - 427
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
IS - 5
ER -