Adrenergic agonists may be more suitable

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A new study finds that α2Adrenergic agonists can be beneficial and have fewer side effects than stimulant medications for the treatment of attention deficit / hyperactivity disorder (ADHD) in preschool children.

The study was published online May 4 a JAMA.

As part of a retrospective analysis, Elizabeth Harstad, MD, MPH, of Boston Children’s Hospital, Boston, Massachusetts, and colleagues evaluated health record data from 497 preschool children with ADHD in seven pediatric behavioral development practices in the United States. The children included in the evaluation were under 6 years of age and were treated for ADHD between January 1, 2013 and July 1, 2017, with α2-adrenergic or stimulant agonist.

Overall, 175 children (35%) were prescribed an α2-adrenergic agonist (most often guanfacin) as a first-line medication for ADHD, and 322 children (65%) were prescribed a stimulant (most often a preparation based on methylphenidate). Before starting any medication regimen, 62% of children received behavioral therapy.

“These findings suggest that, for some children, there may be a concern about the functioning of a stimulant or the tolerability of a stimulant that leads clinicians to prescribe an α2-adrenergic agonist as the first drug tested, “Harstad said Medscape Medical News.

Clinical improvement was observed in 66% of children treated with α2-adrenergic agonists (95% CI, 57.5% to 73.9%) and in 78% of children treated with stimulants (95% CI, 72.4% to 83.4%).

Most adverse effects were more common among children who received stimulants than among those who received α2-adrenergic agonists. These adverse effects included difficulty falling asleep (21% vs. 11%), decreased appetite (38% vs. 7%), increased stomach upset (13% vs. 5%), and increased repetitive behaviors. skin collection (11% vs 5%). Only daytime sleepiness was more common among children receiving α2-adrenergic agonist instead of a stimulant (38% vs 3%).

“We also found that for younger children (<4 years), those initiated with α2Adrenergic agonists remained in these drugs for longer than those initiated in stimulants, which may indicate that they are better tolerated, although more research is needed to confirm this, ”Harstad said.

“While our study focused on the proper functioning of medications and their tolerance when used to treat preschool children with ADHD, it is important to remember that behavioral therapy is recommended as a first-line treatment for to ADHD in preschool children, not drugs, ”Harstad added.

Mark Wolraich, MD, FAAP, University of Oklahoma, Oklahoma City, Oklahoma, echoed that sentiment. “The article mentions that behavioral interventions, in the form of parent training in behavior management, are an effective first-line treatment” and, according to guidelines from the American Academy of Pediatrics (AAP), “is the first recommended line of treatment for preschool children. children in pre-medication age. “

Wolraich also notes that “neither drug has official FDA [US Food and Drug Administration] approval in this age group “but this”methylphenidate it is the closest to having met the FDA requirements for approval in this age group, which is why AAP guidelines recommend its use if parental training in behavior management is not sufficient. ”

Although Harstad and colleagues point out that the study included a large and diverse sample from across the United States, they acknowledge that “more research, including randomized clinical trials, is needed to evaluate the comparative efficacy of α.2-adrenergic agonists vs stimulants “.

Funding for the study was provided through a cooperation agreement with the Office of Maternal and Child Health, the Administration of Health Resources and Services, and the U.S. Department of Health and Human Services. Harstad reported that he has received compensation for serving as a medical reviewer at Understood.org and that he has provided funding from the Palmer Family Fund for Autism Research to conduct research related to autistic spectrum disorder at Boston Children’s Hospital. Disclosures for other authors appear in the original article. Wolraich has not revealed any relevant financial relationship.

JAMA. Published online May 4, 2021. Full text

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