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Atomoxetine versus stimulants for treatment of attention deficit/hyperactivity disorder.
Ann Pharmacother. 2006 Jun; 40(6):1134-42.AP

Abstract

OBJECTIVE

To identify, review, and analyze studies comparing atomoxetine with psychostimulants with the intent of determining the role of atomoxetine in the pharmacologic management of attention deficit/hyperactivity disorder (ADHD).

DATA SOURCES

Primary, review, and meta-analysis articles were identified by a MEDLINE search (1966-December 2005). MeSH headings used in the search include: attention deficit/hyperactivity disorder, ADHD, atomoxetine, stimulants, psychostimulants, methylphenidate, and amphetamine salts. Relevant data presented at professional meetings that we attended were also identified.

STUDY SELECTION AND EXTRACTION

All clinical studies comparing atomoxetine with psychostimulants, regardless of study design, were evaluated. Relevant efficacy and safety data from these studies were included in the discussion.

DATA SYNTHESIS

At time of writing, 5 head-to-head trials had compared psychostimulants and atomoxetine in the treatment of ADHD. No significant difference between atomoxetine and methylphenidate immediate-release were found on the ADHD Rating Scale total score. Osmotic oral release system (OROS) methylphenidate showed significantly greater improvement at weeks 1 and 2, and significantly more patients treated with OROS methylphenidate were classified as responders. Patients on both atomoxetine and mixed amphetamine salts extended-release (MAS XR) showed significant improvements at endpoint over baseline; however, Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) scores were significantly better with MAS XR. Tolerability was similar between atomoxetine and stimulant medications.

CONCLUSIONS

Based on available evidence, psychostimulants are regarded as first-line pharmacologic treatment for children and adolescents with ADHD, as the efficacy and safety of these agents have been well established based on clinical trials and extensive naturalistic use. Adverse effects in some patients and abuse potential have led to the search for new treatments. Atomoxetine represents an alternative treatment for ADHD and is unlikely to be associated with abuse; however, long-term safety data are needed to further establish its place in therapy.

Authors+Show Affiliations

College of Pharmacy, The University of Texas at Austin, 78712, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

16735655

Citation

Gibson, Aaron P., et al. "Atomoxetine Versus Stimulants for Treatment of Attention Deficit/hyperactivity Disorder." The Annals of Pharmacotherapy, vol. 40, no. 6, 2006, pp. 1134-42.
Gibson AP, Bettinger TL, Patel NC, et al. Atomoxetine versus stimulants for treatment of attention deficit/hyperactivity disorder. Ann Pharmacother. 2006;40(6):1134-42.
Gibson, A. P., Bettinger, T. L., Patel, N. C., & Crismon, M. L. (2006). Atomoxetine versus stimulants for treatment of attention deficit/hyperactivity disorder. The Annals of Pharmacotherapy, 40(6), 1134-42.
Gibson AP, et al. Atomoxetine Versus Stimulants for Treatment of Attention Deficit/hyperactivity Disorder. Ann Pharmacother. 2006;40(6):1134-42. PubMed PMID: 16735655.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atomoxetine versus stimulants for treatment of attention deficit/hyperactivity disorder. AU - Gibson,Aaron P, AU - Bettinger,Tawny L, AU - Patel,Nick C, AU - Crismon,M Lynn, Y1 - 2006/05/30/ PY - 2006/6/1/pubmed PY - 2006/8/24/medline PY - 2006/6/1/entrez SP - 1134 EP - 42 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 40 IS - 6 N2 - OBJECTIVE: To identify, review, and analyze studies comparing atomoxetine with psychostimulants with the intent of determining the role of atomoxetine in the pharmacologic management of attention deficit/hyperactivity disorder (ADHD). DATA SOURCES: Primary, review, and meta-analysis articles were identified by a MEDLINE search (1966-December 2005). MeSH headings used in the search include: attention deficit/hyperactivity disorder, ADHD, atomoxetine, stimulants, psychostimulants, methylphenidate, and amphetamine salts. Relevant data presented at professional meetings that we attended were also identified. STUDY SELECTION AND EXTRACTION: All clinical studies comparing atomoxetine with psychostimulants, regardless of study design, were evaluated. Relevant efficacy and safety data from these studies were included in the discussion. DATA SYNTHESIS: At time of writing, 5 head-to-head trials had compared psychostimulants and atomoxetine in the treatment of ADHD. No significant difference between atomoxetine and methylphenidate immediate-release were found on the ADHD Rating Scale total score. Osmotic oral release system (OROS) methylphenidate showed significantly greater improvement at weeks 1 and 2, and significantly more patients treated with OROS methylphenidate were classified as responders. Patients on both atomoxetine and mixed amphetamine salts extended-release (MAS XR) showed significant improvements at endpoint over baseline; however, Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) scores were significantly better with MAS XR. Tolerability was similar between atomoxetine and stimulant medications. CONCLUSIONS: Based on available evidence, psychostimulants are regarded as first-line pharmacologic treatment for children and adolescents with ADHD, as the efficacy and safety of these agents have been well established based on clinical trials and extensive naturalistic use. Adverse effects in some patients and abuse potential have led to the search for new treatments. Atomoxetine represents an alternative treatment for ADHD and is unlikely to be associated with abuse; however, long-term safety data are needed to further establish its place in therapy. SN - 1060-0280 UR - https://www.unboundmedicine.com/medline/citation/16735655/Atomoxetine_versus_stimulants_for_treatment_of_attention_deficit/hyperactivity_disorder_ L2 - https://journals.sagepub.com/doi/10.1345/aph.1G582?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -