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α2-肾上腺素能激动剂或兴奋剂治疗学龄前儿童注意缺陷多动障碍疗效显著
作者:小柯机器人 发布时间:2021/5/7 18:20:16

美国波士顿儿童医院Elizabeth Harstad团队研究了α2-肾上腺素能激动剂或兴奋剂治疗学龄前儿童注意缺陷多动障碍的疗效。2021年5月3日,《美国医学会杂志》发表了这一成果。

大约2.4%的学龄前儿童被诊断为注意缺陷/多动障碍(ADHD)。建议将兴奋剂作为一线药物治疗。然而,高达25%的学龄前儿童多动症采用α2-肾上腺素能激动剂药物治疗,尽管很少有证据表明该药在这个年龄段的疗效或不良反应。

为了确定学龄前儿童初始ADHD药物治疗中,与α2-肾上腺素能激动剂和兴奋剂治疗相关的ADHD症状和不良反应改善的频率,研究组进行了一项回顾性电子健康记录分析。这些数据来自美国发展行为儿科研究网络的7个门诊儿童发展行为实践的健康记录。2013年1月1日至2017年7月1日,497名小于72个月的儿童接受了一名发育行为儿科医生的α2-肾上腺素能激动剂或兴奋剂药物治疗。主要结局为ADHD症状和不良反应的改善。

根据497名学龄前多动症儿童的电子健康记录,ADHD药物治疗开始时,这些儿童年龄中位数为62个月,409名(82%)为男孩。对于首次ADHD药物治疗,175名儿童服用α2-肾上腺素能激动剂(35%),322名儿童服用兴奋剂(65%)。α2-肾上腺素能激动剂组的儿童中有66%病情改善,兴奋剂组的儿童中有78%改善。

α2-肾上腺素能激动剂组中有38%的儿童白天更嗜睡,显著高于兴奋剂组(3%)。兴奋剂组中的几种不良反应,喜怒无常/易怒发生率为50%,食欲不振发生率为38%,睡眠困难发生率为21%,均显著高于α2-肾上腺素能激动剂组,分别为29%、7%和11%。

研究结果表明,对于大多数接受α2-肾上腺素能激动剂或兴奋剂治疗的多动症儿童,使用不同药物治疗后不良反应差异较大。

附:英文原文

Title: α2-Adrenergic Agonists or Stimulants for Preschool-Age Children With Attention-Deficit/Hyperactivity Disorder

Author: Elizabeth Harstad, Justine Shults, William Barbaresi, Ami Bax, Jaclyn Cacia, Alexis Deavenport-Saman, Sandra Friedman, Angela LaRosa, Irene M. Loe, Shruti Mittal, Shelby Tulio, Douglas Vanderbilt, Nathan J. Blum

Issue&Volume: 2021-05-04

Abstract:

Importance  Attention-deficit/hyperactivity disorder (ADHD) is diagnosed in approximately 2.4% of preschool-age children. Stimulants are recommended as first-line medication treatment. However, up to 25% of preschool-age children with ADHD are treated with α2-adrenergic agonist medications, despite minimal evidence about their efficacy or adverse effects in this age range.

Objective  To determine the frequency of reported improvement in ADHD symptoms and adverse effects associated with α2-adrenergic agonists and stimulant medication for initial ADHD medication treatment in preschool-age children.

Design, Setting, and Participants  Retrospective electronic health record review. Data were obtained from health records of children seen at 7 outpatient developmental-behavioral pediatric practices in the Developmental Behavioral Pediatrics Research Network in the US. Data were abstracted for 497 consecutive children who were younger than 72 months when treatment with an α2-adrenergic agonist or stimulant medication was initiated by a developmental-behavioral pediatrician for ADHD and were treated between January 1, 2013, and July 1, 2017. Follow-up was complete on February 27, 2019.

Exposures  α2-Adrenergic agonist vs stimulant medication as initial ADHD medication treatment.

Main Outcomes and Measures  Reported improvement in ADHD symptoms and adverse effects.

Results  Data were abstracted from electronic health records of 497 preschool-age children with ADHD receiving α2-adrenergic agonists or stimulants. Median child age was 62 months at ADHD medication initiation, and 409 children (82%) were males. For initial ADHD medication treatment, α2-adrenergic agonists were prescribed to 175 children (35%; median length of α2-adrenergic agonist use, 136 days) and stimulants were prescribed to 322 children (65%; median length of stimulant use, 133 days). Improvement was reported in 66% (95% CI,57.5%-73.9%) of children who initiated α2-adrenergic agonists and 78% (95% CI, 72.4%-83.4%) of children who initiated stimulants. Only daytime sleepiness was more common for those receiving α2-adrenergic agonists vs stimulants (38% vs 3%); several adverse effects were reported more commonly for those receiving stimulants vs α2-adrenergic agonists, including moodiness/irritability (50% vs 29%), appetite suppression (38% vs 7%), and difficulty sleeping (21% vs 11%).

Conclusions and Relevance  In this retrospective review of health records of preschool-age children with ADHD treated in developmental-behavioral pediatric practices, improvement was noted in the majority of children who received α2-adrenergic agonists or stimulants, with differing adverse effect profiles between medication classes. Further research, including from randomized clinical trials, is needed to assess comparative effectiveness of α2-adrenergic agonists vs stimulants.

DOI: 10.1001/jama.2021.6118

Source: https://jamanetwork.com/journals/jama/fullarticle/2779699

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex