Childress Ann, Sottile Robert, Khanbijian Sherine
Center for Psychiatry and Behavioral Medicine, Inc, Las Vegas, NV, USA.
Kirk Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV, USA.
Expert Rev Neurother. 2023 Jul-Dec;23(11):945-953. doi: 10.1080/14737175.2023.2265068. Epub 2023 Oct 27.
Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder with symptoms that may persist in up to 90% of adults diagnosed during childhood and continue to cause significant impairment throughout the lifespan. In the United States (US), amphetamine and methylphenidate formulations have been available to treat ADHD for several decades. Only one nonstimulant, atomoxetine, was available for the treatment of ADHD in adults until recently. In April 2022, a second nonstimulant, viloxazine extended-release (VLX-ER), became available in the US for the treatment of adult ADHD. Efficacy was previously established in placebo-controlled trials in children and adolescents.
VLX-ER is a norepinephrine reuptake inhibitor with serotonin activity. The efficacy in adults, adverse event profile, pharmacokinetics, drug-drug interactions, and metabolism of VLX-ER are reviewed.
Despite the availability of effective pharmacological treatments for ADHD, many patients discontinue treatment in less than 1 year. Stimulants are effective in more than 80% of patients; however, some may have difficulty tolerating them. Although there were no head-to-head studies, the effect size of VLX-ER in an adult efficacy trial was lower than has been shown for stimulants. Nevertheless, the approval of VLX-ER adds another effective ADHD treatment option for adults.
注意力缺陷多动障碍（ADHD）是一种常见的神经行为障碍，其症状可能在高达90%的童年期被诊断出的成年人中持续存在，并在整个生命周期中继续造成严重损害。在美国，苯丙胺和哌甲酯制剂已用于治疗ADHD数十年。直到最近，成人ADHD的治疗仅有非兴奋剂托莫西汀这一种药物可用。2022年4月，第二种非兴奋剂维洛沙嗪缓释片（VLX-ER）在美国上市，用于治疗成人ADHD。此前已在儿童和青少年的安慰剂对照试验中确定了其疗效。
VLX-ER是一种具有血清素活性的去甲肾上腺素再摄取抑制剂。本文对VLX-ER在成人中的疗效、不良事件谱、药代动力学、药物相互作用及代谢进行了综述。
尽管有有效的ADHD药物治疗方法，但许多患者在不到1年的时间内就停止了治疗。兴奋剂对超过80%的患者有效；然而，一些患者可能难以耐受。虽然没有头对头研究，但在一项成人疗效试验中，VLX-ER的效应量低于兴奋剂所显示的效应量。尽管如此，VLX-ER的获批为成人ADHD增加了另一种有效的治疗选择。
