Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark.
Copenhagen Research Centre on Mental Health (CORE), Copenhagen University Hospital, 2900, Hellerup, Denmark.
Eur Child Adolesc Psychiatry. 2024 Feb;33(2):357-367. doi: 10.1007/s00787-023-02158-z. Epub 2023 Feb 16.
This study investigates early onset of treatment response as predictor of symptomatic and functional outcome 3 years after initiation of methylphenidate (MPH) administration in a naturalistic, clinical cohort of children and adolescents with ADHD. Children were followed across an initial 12-week MPH treatment trial and after 3 years, with ratings of symptoms and impairment. Associations between a clinically significant MPH treatment response in week 3 (defined as ≥ 20% reduction in clinician-rated symptoms) and in week 12 (defined as ≥ 40% reduction), and 3-year outcome were tested in multivariate linear regression models, adjusting for sex, age, comorbidity, IQ, maternal education, parental psychiatric disorder, and baseline symptoms and function. We did not have information on treatment adherence or the nature of treatments beyond 12 weeks. 148 children, mean age 12.4 years (range 10-16 years), 77% males, participated in the follow-up. We found a significant decrease in symptom score from baseline [M = 41.9 (SD = 13.2)] to 3-year follow-up [M = 27.5 (SD = 12.7), p < 0.001, and in impairment score from baseline (M = 41.6 (SD = 19.4)] to 3-year follow-up [M = 35.6 (SD = 20.2), p = 0.005]. Treatment responses in week 3 and week 12 were significant predictors of the long-term outcome of symptoms, but not of impairment at 3-year follow-up, when adjusting for other well-known predictors. Early treatment response predicts long-term outcome over and above other well-known predictors. Clinicians should follow-up patients carefully, during the first months of treatment, and detect non-responders, since there might be a window of opportunity to alter the outcome, by changing the treatment strategy.Clinical trial registration: ClinicalTrials.gov, registration number NCT04366609, April 28, 2020 retrospectively registered.
这项研究调查了在自然临床队列中，儿童和青少年 ADHD 患者在开始使用哌醋甲酯（MPH）治疗后的 3 年内，早期治疗反应作为症状和功能结果的预测指标。儿童在初始的 12 周 MPH 治疗试验中进行了随访，并在 3 年后进行了症状和功能障碍的评估。在多元线性回归模型中，我们检验了第 3 周（定义为临床症状评分降低≥20%）和第 12 周（定义为临床症状评分降低≥40%）时具有临床意义的 MPH 治疗反应与 3 年结果之间的关联，调整了性别、年龄、合并症、智商、母亲教育程度、父母精神疾病、基线症状和功能。我们没有关于治疗依从性或 12 周后治疗性质的信息。共有 148 名儿童（平均年龄 12.4 岁，范围为 10-16 岁），77%为男性，参加了随访。我们发现，从基线到 3 年随访时，症状评分显著下降[M=41.9（SD=13.2）]，[M=27.5（SD=12.7），p<0.001]，从基线到 3 年随访时，功能障碍评分显著下降[M=41.6（SD=19.4）]，[M=35.6（SD=20.2），p=0.005]。第 3 周和第 12 周的治疗反应是症状长期预后的显著预测因素，但在调整其他已知预测因素后，并不是 3 年随访时功能障碍的预测因素。早期治疗反应预测长期结果，超过了其他已知的预测因素。临床医生应该在治疗的最初几个月仔细随访患者，并发现无反应者，因为通过改变治疗策略，可能有机会改变结果。临床试验注册：ClinicalTrials.gov，注册号 NCT04366609，2020 年 4 月 28 日回顾性注册。
