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Observational Study
. 2024 Apr;34(3):137-147.
doi: 10.1089/cap.2023.0077.

Switch to Lisdexamfetamine in the Treatment of Attention-Deficit Disorder at a Psychiatric Outpatient Clinic for School-Aged Children: A Danish Cohort Study

Nanna Roed Søndergaard  1 , Karen Busk Nørøxe  1 , Anders Helles Carlsen  1 , Stine Helene Randing  1 , Pernille Warrer  2 , Per Hove Thomsen  1   3 , Loa Clausen  1   3
Affiliations
Observational Study

Switch to Lisdexamfetamine in the Treatment of Attention-Deficit Disorder at a Psychiatric Outpatient Clinic for School-Aged Children: A Danish Cohort Study

Nanna Roed Søndergaard et al. J Child Adolesc Psychopharmacol. 2024 Apr.

Abstract

Objectives: This study aimed to examine switch from first-line methylphenidate (MPH) to lisdexamfetamine (LDX) in school-aged children with attention-deficit/hyperactivity disorder (ADHD). Methods: This is a retrospective observational study based on systematic review of patient records of all children (7-13 years) diagnosed with ADHD and referred to a Danish specialized outpatient clinic. The study included 394 children switching from MPH to LDX as either second-line or third-line treatment (atomoxetine [ATX] as second-line treatment) during the study period from April 1, 2013, to November 5, 2019. Results: One in five children switched from MPH to LDX at some point during the study period. The most frequent reasons for switching to LDX were adverse effects (AEs; 70.0% for MPH, 68.3% for ATX) and lack of efficiency (52.0% for MPH, 72.7% for ATX). Top five AEs of LDX were decreased appetite (62.4%), insomnia (28.7%), irritability/aggression (26.1%), weight decrease (21.1%), and mood swings (13.9%). MPH and LDX had similar AE profiles, yet most AEs were less frequent after switching to LDX. At the end of the study period, the majority were prescribed LDX as second-line rather than third-line treatment (86.1% in 2019). However, the likelihood of LDX as second-line treatment decreased with the number of psychiatric comorbidities, ADHD symptom severity as assessed by parents, and if AEs were a reason for MPH discontinuation. Among children observed for at least 1 year after initiation of LDX, 41.3% continued LDX treatment for a year or longer. LDX continuation was less likely if AEs were a reason for MPH discontinuation. Similarly to MPH and ATX, the most frequent reasons for LDX discontinuation were AEs (74.4%) and lack of efficiency (34.7%). Implications: The findings support LDX as an important option in the personalized treatment of children with ADHD and may support prescribers in the clinical decision-making on switching medication.

Keywords: adverse effects; attention-deficit/hyperactivity disorder; child and adolescent psychiatry; lisdexamfetamine; treatment.

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Conflict of interest statement

All authors declare that they have no conflicts of interest. No competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
Flowchart of patients included in the study, and an overview of line of treatment and LDX treatment status at the end of the study period.
See this image and copyright information in PMC

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