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Combination therapy more effective than monotherapy for ADHD
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A combination of d-methylphenidate and guanfacine was more effective for attention-deficit/hyperactivity disorder than either treatment alone, according to recent findings.
“Despite symptom reduction with monotherapies, there is little evidence to show that medications change long-term trajectories of either symptoms or academic, psychiatric, and social outcomes, although some acute and follow-up studies find modest academic gains. The discordance between symptom reduction from standard treatments and continued impaired functioning long term highlights the importance of identifying treatments that better remediate proximal causes of negative outcomes,” James T. McCracken, MD, of the David Geffen School of Medicine at University of California, Los Angeles, and colleagues wrote.
James T. McCracken
To compare efficacy of extended-release d-methylphenidate, a combined dopamine and noradrenergic agonist, with guanfacine, an 2A receptor agonist, researchers conducted an 8-week randomized, double-blind, comparative trial among 207 children aged 7 to 14 years with DSM-IV ADHD. Study participants received guanfacine at 1 mg to 3 mg per day, d-methylphenidate at 5 mg to 20 mg per day, or a combination with fixed flexible dosing.
Overall, there were significant treatment group main effects for ADHD Rating Scale IV (ADHD-RS-IV) ADHD total (P = .0001) and inattentive symptoms (P = .0001).
Participants who received combination therapy had small but consistently greater reductions in ADHD-RS-IV inattentive subscale scores compared with monotherapy of d-methylphenidate (P = .05) or guanfacine (P = .02).
Combination therapy was associated with a greater positive response rate indicated by Clinical Global Impression Improvement scores (P = .01).
No serious cardiovascular events occurred.
Sedation, somnolence, lethargy and fatigue were more common in the guanfacine group.
All treatments were well-tolerated, according to researchers.
“Results from our study suggest modest but consistent additional benefit from a carefully applied combination of a psychostimulant with a selective 2A agonist, guanfacine, on ADHD symptoms and global clinical responses. Our findings should also serve to encourage further research to identify a range of treatment strategies using other possible approaches to successfully improve the long-term trajectory of ADHD,” the researchers concluded. – by Amanda Oldt
Disclosure: McCracken reports receiving consultant honoraria from Dart Neuroscience and Think Now Inc. Please see the full study for a list of all authors’ relevant financial disclosures.
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