Tzang Ruu-Fen, Chang Yue-Cune, Tsai Guochuan E, Lane Hsien-Yuan
Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
Department of Mathematics, Tamkang University, Taipei, Taiwan.
J Psychopharmacol. 2016 Oct;30(10):976-82. doi: 10.1177/0269881116658986. Epub 2016 Jul 21.
Methylphenidate, a stimulant that activates dopaminergic and noradrenergic function, is an important agent in the treatment of attention deficit hyperactivity disorder (ADHD). Sarcosine, a glycine transporter-1 inhibitor, may also play a role in treating ADHD by modulating the glutamatergic neurotransmission system through activating N-methyl-D-aspartate type glutamate receptors. This study aimed to assess the efficacy of sarcosine in treating children with ADHD. We conducted a six-week, randomized, double-blind, placebo-controlled clinical trial. The primary outcome measures were those on the Inattention, Hyperactivity/impulsivity, and oppositional defiant disorder (ODD) subscales of the Swanson, Nolan, and Pelham, version IV scale. Efficacy and safety were measured bi-weekly. A total of 116 children with ADHD were enrolled. Among them, 48 (83%) of the 58 sarcosine recipients and 44 (76%) of the 58 placebo recipients returned for the first post-treatment visit. The missing data values were imputed by the last observation carry forward method. From a multiple linear regression analysis, using the generalized estimating equation approach, and an intention to treat analysis, the efficacy of sarcosine marginally surpassed that of placebo at weeks 2, 4, and 6, with p-values=0.01, 0.026, and 0.012, respectively, although only for ODD symptoms. Treatment of ADHD by sarcosine (0.03 g/kg/day) was well tolerated. Sarcosine could possibly be a novel agent for managing ODD symptoms in the context of ADHD. However, future larger-scale studies are warranted to optimize its dosage.
哌甲酯是一种可激活多巴胺能和去甲肾上腺素能功能的兴奋剂，是治疗注意力缺陷多动障碍（ADHD）的重要药物。肌氨酸是一种甘氨酸转运体-1抑制剂，它可能通过激活N-甲基-D-天冬氨酸型谷氨酸受体来调节谷氨酸能神经传递系统，从而在ADHD治疗中发挥作用。本研究旨在评估肌氨酸治疗ADHD患儿的疗效。我们进行了一项为期六周的随机双盲安慰剂对照临床试验。主要结局指标是斯旺森、诺兰和佩勒姆第四版量表中注意力不集中、多动/冲动及对立违抗障碍（ODD）分量表的指标。每两周测量一次疗效和安全性。共招募了116名ADHD患儿。其中，58名接受肌氨酸治疗的患儿中有48名（83%）、58名接受安慰剂治疗的患儿中有44名（76%）返回进行首次治疗后随访。缺失数据值采用末次观察结转法进行估算。通过多线性回归分析、使用广义估计方程法以及意向性分析，肌氨酸的疗效在第2周、第4周和第6周时略超过安慰剂，p值分别为0.01、0.026和0.012，不过仅针对ODD症状。肌氨酸（0.03 g/kg/天）治疗ADHD的耐受性良好。在ADHD背景下，肌氨酸可能是一种治疗ODD症状的新型药物。然而，未来需要进行更大规模的研究以优化其剂量。
