Experience in the use of lisdexamfetamine in the management of ADHD of children and adolescents
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https://doi.org/10.31766/revpsij.v35n3a2Keywords:
ADHD, LDX, Psychostimulants, Treatment, Therapeutic profile, Pro-drugAbstract
Introduction: Attention deficit hyperactivity disorder (ADHD) is one of the most frequent neurodevelopmental disorders, with an estimated worldwide prevalence of approximately 5% [1,2]. Until a few years ago, the pharmacological options in Spain for the treatment of ADHD were basically confined to methylphenidate in its different presentations (MFD), and to Atomoxetine (ATX). Since 2014 we have in our therapeutic arsenal the lisdexanfetamine dimesylate (LDX); which is the first long-term psychostimulant with prodrug technology, approved for use in Spain in children in whom there has been an inadequate response to treatment with methylphenidate, from 6 years of age.
With the advent of guanfancine in 2016, we have witnessed a considerable expansion of the range of pharmacological therapeutic options available to us, thus enabling a more effective control of the core symptoms of ADHD.
Objectives: The main objective of this work focuses on the description and characterization of a population of children and adolescents diagnosed with ADHD, in which a LDX therapeutic trial was conducted.
Based on the results obtained and the review of the literature, the different “scenarios” are presented in which the use of LDX has proved to be especially useful in the management of children and adolescents with ADHD.
Material and Methods: A longitudinal and descriptive study was carried out, in which the different responses obtained with LDX were reviewed on the one hand according to the clinical characteristics of the population under analysis (children and adolescents between 6 and 18 years old). with a diagnosis of ADHD, previously exposed to different MFD and / or ATX guidelines), as well as the tolerability profile and side effects presented.
Results: 200 patients were included in the study (n = 200), of which 140 were males and 60 girls (relation between males / girls 2.3), with a range of ages between 6 and 18 years, and an average of age of 15 years.
Of the 200 patients included, 178 (89%) had a good or very good response, while the remaining 22 (11%) had an inadequate response and / or a rate of side effects that led to the suspension of treatment with LDX.
Those who responded best to the change to LDX were those individuals in whom there was a partial prior response to different pharmacological guidelines, in which they needed multiple doses of MFD to obtain better coverage throughout the day, or in which there were undesirable effects. about “character” (especially in adolescents without other associated comorbidities).
89% of the patients presented side effects of mildmoderate intensity (in line with those already described with psychostimulants), with a tendency to improve or disappear with the passage of time. There were no serious side effects in the series analyzed.
Conclusions: There is a clinical profile of patients diagnosed with ADHD in whom the use of LDX seems to show a high efficacy profile, with adequate tolerability in the short, medium and long term; and an acceptable rate of side effects.
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