Vitiello B, Severe J B, Greenhill L L, Arnold L E, Abikoff H B, Bukstein O G, Elliott G R, Hechtman L, Jensen P S, Hinshaw S P, March J S, Newcorn J H, Swanson J M, Cantwell D P
Child and Adolescent Treatment and Preventive Intervention Research Branch, Division of Services and Intervention Research, NIMH, MSC 9633, Bethesda, MD 20982-9633, USA.
J Am Acad Child Adolesc Psychiatry. 2001 Feb;40(2):188-96. doi: 10.1097/00004583-200102000-00013.
To examine the trajectory of methylphenidate (MPH) dosage over time, following a controlled titration, and to ascertain how accurately the titration was able to predict effective long-term treatment in children with attention-deficit/hyperactivity disorder (ADHD).
Using the 14-month-treatment database of the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA), the outcome of the initial placebo-controlled, double-blind, randomized daily switch titration of MPH was compared with the subsequent maintenance pharmacotherapy. Children received monthly monitoring visits and, when needed, medication adjustments.
Of the 198 children for whom MPH was the optimal treatment at titration (mean +/- SD dose: 30.5 +/- 14.2 mg/day), 88% were still taking MPH at the end of maintenance (mean dose 34.4 +/- 13.3 mg/day). Titration-determined dose and end-of-maintenance dose were significantly correlated (r = 0.52-0.68). Children receiving combined pharmacotherapy and behavioral treatment ended maintenance on a lower dose (31.1 +/- 11.7 mg/day) than did children receiving pharmacotherapy only (38.1 +/- 14.2 mg/day). Of the 230 children for whom titration identified an optimal treatment, 17% continued both the assigned medication and dosage throughout maintenance. The mean number of pharmacological changes per child was 2.8 +/- 1.8 (SD), and time to first change was 4.7 months +/- 0.3 (SE).
For most children, initial titration found a dose of MPH in the general range of the effective maintenance dose, but did not prevent the need for subsequent maintenance adjustments. For optimal pharmacological treatment of ADHD, both careful initial titration and ongoing medication management are needed.
在进行对照滴定后，研究哌甲酯（MPH）剂量随时间的变化轨迹，并确定滴定能够多准确地预测注意力缺陷多动障碍（ADHD）儿童的有效长期治疗效果。
使用美国国立精神卫生研究所（NIMH）儿童注意力缺陷多动障碍协作多中心多模式治疗研究（MTA）的14个月治疗数据库，将MPH最初的安慰剂对照、双盲、随机每日转换滴定结果与随后的维持药物治疗进行比较。儿童每月接受监测访视，并在需要时进行药物调整。
在滴定中MPH为最佳治疗药物的198名儿童中（平均±标准差剂量：30.5±14.2毫克/天），88%在维持治疗结束时仍在服用MPH（平均剂量34.4±13.3毫克/天）。滴定确定的剂量与维持治疗结束时的剂量显著相关（r = 0.52 - 0.68）。接受药物治疗与行为治疗相结合的儿童在维持治疗结束时的剂量（31.1±11.7毫克/天）低于仅接受药物治疗的儿童（38.1±14.2毫克/天）。在滴定确定了最佳治疗方案的230名儿童中，17%在整个维持治疗期间继续使用指定的药物和剂量。每个儿童的药物变化平均次数为2.8±1.8（标准差），首次变化时间为4.7个月±0.3（标准误）。
对于大多数儿童，初始滴定发现的MPH剂量在有效维持剂量的一般范围内，但并不能避免后续维持治疗调整的必要性。对于ADHD的最佳药物治疗，既需要仔细的初始滴定，也需要持续的药物管理。
