Atomoxetine for the treatment of attention-deficit/hyperactivity disorder and oppositional defiant disorder

TY - JOUR

T1 - Atomoxetine for the treatment of attention-deficit/hyperactivity disorder and oppositional defiant disorder

AU - Bangs, Mark E.

AU - Hazell, Philip

AU - Danckaerts, Marina

AU - Hoare, Peter

AU - Coghill, David R.

AU - Wehmeier, Peter M.

AU - Williams, David W.

AU - Moore, Rodney J.

AU - Levine, Louise

AU - Atomoxetine ADHD Odd Study Grp

PY - 2008/2

Y1 - 2008/2

N2 - OBJECTIVE. In this study we examined the effectiveness of atomoxetine for the treatment of oppositional defiant disorder comorbid with attention-deficit/hyperactivity disorder.METHODS. Patients were aged 6 to 12 years and met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for attention-deficit/hyperactivity disorder with a Swanson, Nolan, and Pelham Rating Scale-Revised attention-deficit/hyperactivity disorder subscale score above age and gender norms; Clinical Global Impressions-Severity Scale score of >= 4; and Swanson, Nolan, and Pelham Rating Scale-Revised oppositional defiant disorder subscale score of >= 15. Patients were randomly assigned in a 2: 1 ratio to receive 1.2 mg/kg per day of atomoxetine (n = 156) or placebo (n = 70) for 8 weeks. Treatment effect on oppositional defiant disorder and attention-deficit/hyperactivity disorder symptoms was measured by using the investigator-rated Swanson, Nolan, and Pelham Rating Scale-Revised.RESULTS. Repeated-measures analysis demonstrated a statistically significant difference favoring atomoxetine over placebo in the reduction of Swanson, Nolan, and Pelham Rating Scale-Revised oppositional defiant disorder total scores. There were significant pairwise treatment differences at weeks 2 and 5 but not at week 8 postbaseline. A last-observation-carried-forward analysis showed Swanson, Nolan, and Pelham Rating Scale-Revised scores at endpoint for the atomoxetine and placebo groups were significantly different for attention-deficit/hyperactivity disorder symptoms but not for oppositional defiant disorder symptoms. Atomoxetine was superior to placebo in a last-observation-carried-forward analysis of Clinical Global Impression-Improvement and Clinical Global Impression-Severity scores.CONCLUSIONS. This study confirms previous findings that patients with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder show statistically and clinically significant improvement in attention-deficit/hyperactivity disorder symptoms and global clinical functioning when treated with atomoxetine. It remains uncertain, however, whether atomoxetine exerts a specific and enduring effect on oppositional defiant disorder symptoms.

AB - OBJECTIVE. In this study we examined the effectiveness of atomoxetine for the treatment of oppositional defiant disorder comorbid with attention-deficit/hyperactivity disorder.METHODS. Patients were aged 6 to 12 years and met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for attention-deficit/hyperactivity disorder with a Swanson, Nolan, and Pelham Rating Scale-Revised attention-deficit/hyperactivity disorder subscale score above age and gender norms; Clinical Global Impressions-Severity Scale score of >= 4; and Swanson, Nolan, and Pelham Rating Scale-Revised oppositional defiant disorder subscale score of >= 15. Patients were randomly assigned in a 2: 1 ratio to receive 1.2 mg/kg per day of atomoxetine (n = 156) or placebo (n = 70) for 8 weeks. Treatment effect on oppositional defiant disorder and attention-deficit/hyperactivity disorder symptoms was measured by using the investigator-rated Swanson, Nolan, and Pelham Rating Scale-Revised.RESULTS. Repeated-measures analysis demonstrated a statistically significant difference favoring atomoxetine over placebo in the reduction of Swanson, Nolan, and Pelham Rating Scale-Revised oppositional defiant disorder total scores. There were significant pairwise treatment differences at weeks 2 and 5 but not at week 8 postbaseline. A last-observation-carried-forward analysis showed Swanson, Nolan, and Pelham Rating Scale-Revised scores at endpoint for the atomoxetine and placebo groups were significantly different for attention-deficit/hyperactivity disorder symptoms but not for oppositional defiant disorder symptoms. Atomoxetine was superior to placebo in a last-observation-carried-forward analysis of Clinical Global Impression-Improvement and Clinical Global Impression-Severity scores.CONCLUSIONS. This study confirms previous findings that patients with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder show statistically and clinically significant improvement in attention-deficit/hyperactivity disorder symptoms and global clinical functioning when treated with atomoxetine. It remains uncertain, however, whether atomoxetine exerts a specific and enduring effect on oppositional defiant disorder symptoms.

KW - ADHD

KW - adolescents

KW - atomoxetine

KW - DEFICIT-HYPERACTIVITY DISORDER

KW - CONDUCT PROBLEMS

KW - MIDDLE CHILDHOOD

KW - CHILDREN

KW - COVARIATION

KW - COMORBIDITY

KW - SYMPTOMS

KW - ODD/CD

KW - AD/HD

U2 - 10.1542/peds.2006-1880

DO - 10.1542/peds.2006-1880

M3 - Article

SN - 0031-4005

VL - 121

SP - E314-E320

JO - Pediatrics

JF - Pediatrics

IS - 2

ER -