Long-term changes in management following n-of-1 trials of stimulants in attention-deficit/hyperactivity disorder

Nikles, C. Jane, Mitchell, Geoffrey K., Del Mar, Chris B., McNairn, Norma and Clavarino, Alexandra (2007) Long-term changes in management following n-of-1 trials of stimulants in attention-deficit/hyperactivity disorder. European Journal of Clinical Pharmacology, 63 11: 985-989. doi:10.1007/s00228-007-0361-x


Author Nikles, C. Jane
Mitchell, Geoffrey K.
Del Mar, Chris B.
McNairn, Norma
Clavarino, Alexandra
Title Long-term changes in management following n-of-1 trials of stimulants in attention-deficit/hyperactivity disorder
Journal name European Journal of Clinical Pharmacology   Check publisher's open access policy
ISSN 0031-6970
Publication date 2007-11-01
Year available 2007
Sub-type Article (original research)
DOI 10.1007/s00228-007-0361-x
Open Access Status Not Open Access
Volume 63
Issue 11
Start page 985
End page 989
Total pages 5
Editor Dahlqvist, R.
Place of publication Heidelberg, Germany
Publisher Springer
Language eng
Subject 320503 Clinical Pharmacology and Therapeutics
C1
730199 Clinical health not specific to particular organs, diseases and conditions
Abstract Objective Our objective was to evaluate the long-term impact of n-of-1 trials - within-patient randomised, double-blind, cross-over comparisons of stimulant versus placebo or stimulant - on ADHD management. Methods Telephone surveys at 3, 6 and 12 months. Main outcome measures included (1) changes in treatment before and after the n-of-1 trial, (2) congruence of management at follow-up with trial result, (3) reasons for any non-congruence, and (4) persistence of the joint patient-doctor decision over 12 months. Patients were children with clinically diagnosed ADHD, aged 5-16 years. Results A total of 76 patients were followed up; 12 months' data were available for 67 (88%). Management changed from baseline for 46, 48 and 51% at 3, 6 and 12 months respectively. Most responders, 21/37 (57%), remained on the same stimulant at 12 months, compared to 9/24 (37%) non-responders. Of the remaining non-responders, 15/24 (62%) either switched (2/24, 8%) or ceased stimulants (13/24, 54%). The rate of congruence with the test result was 45/65 (69%) at 3 months, 44/67 (66%) at 6 months and 40/67 (60%) at 12 months. Persistence with the post-trial decision over 12 months was high (79-85%) whether the decision was to continue or to cease stimulants. Conclusions Although not conclusive because there was no control group, our results suggest that n-of-1 trials may improve rational treatment of ADHD.
Keyword Pharmacology & Pharmacy
n-of-1 trials
attention-deficit/hyperactivity disorder
follow-up
stimulant
Deficit Hyperactivity Disorder
Criterion Validity
Crossover Trial
Medication
Adherence
Methylphenidate
Reliability
Children
Scale
Pharmacotherapy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2008 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Tue, 19 Feb 2008, 01:21:20 EST