Dexmethylphenidate Hydrochloride

What is this summary about : This is a plain language summary of 2 articles published in the Journal of Child and Adolescent Psychopharmacol.It describes a medication called serdexmethylphenidate/dexmethylphenidate, or SDX/d-MPH for short.SDX/d-MPH is marketed under the name Azstarys^.It is in capsule form taken by mouth once a day in the morning and meant for treating patients aged 6 years and older with attention-deficit/hyperactivity disorder, commonly referred to as ADHD.This summary focuses on studies that were done in children and adolescents aged 6 to 12 years with ADHD.The study results showed how SDX/d-MPH reduced the symptoms of ADHD, how fast the medication began to work and for how long it worked in the study patients, as well as the medications safety during 1 yr of treatment.What are the key takeaways : Two main studies were done in patients with ADHD.The first study was conducted in a laboratory classroom, which is a simulated school classroom setting with children and adolescents aged 6 to 12 years with ADHD.The patients received either SDX/d-MPH or a placebo.The results of this study showed that the effect of SDX/d-MPH on reducing ADHD symptoms started approx. 30 min after taking the SDX/d-MPH capsule and lasted for approx. 13 h.The placebo did not have this effect.The most common side effects for those taking SDX/d-MPH were headache, abdominal (belly) pain, insomnia and upper respiratory tract infection.The second study was also done in patients aged 6 to 12 years with ADHD.The purpose was to examine how safe and tolerable SDX/d-MPH was during 1 yr of treatment.In this study, no placebo was given.The findings from the second study showed that SDX/d-MPH was safe and tolerable during the 1-yr treatment period, with the most common side effects being decreased appetite, upper respiratory tract Scott H. Kollins1,2, Andrea Marraffino3, Andrew J. Cutler4,5, Charles Oh6, Matthew N. Brams7, Rene Braeckman8 & Ann C. Childress9 1 Duke University School of Medicine, Durham, NC, USA; 2 Akili Interactive, Inc., Boston, MA, USA; 3 Accel Research Sites Network, Maitland, FL, USA; 4 SUNY Upstate Medical University, Syracuse, NY, USA; 5 Neuroscience Education Institute, Lakewood Ranch, FL, USA; 6 Corium LLC, Boston, MA, USA; 7 Bayou City Research, Houston, TX, USA; 8 Zevra Therapeutics Inc, Celebration, FL, USA; 9Center for Psychiatry and Behavioral Medicine, Las Vegas, NV, USA Placebo: an inactive substance that has no medication but looks exactly the same as the actual medication and is taken in exactly the same way as the study drug.Side effect: an undesirable effect of a medication.Insomnia: difficulty sleeping.Tolerable: means that a patient can endure a medication even with the some of the side effects. infection, sore throat and nose, decreased weight and irritability.This study also showed that SDX/d-MPH was effective throughout the 1-yr treatment period.What were the main conclusions : In the first study, children with ADHD treated with SDX/d-MPH showed noticeable improvements in ADHD symptoms as early as 30 min after the medication was given, and those improvements lasted up to 13 h.SDX/d-MPH was also found to be as safe as other ADHD treatments containing methylphenidate (MPH).Results of the second study showed that children with ADHD could be treated safely with SDX/d-MPH.Clin. Trial Registration: NCT03460652 (ClinicalTrials.gov).

In the United States (US), prescription drug coverage is subject to prior authorization (PA) criteria, which may vary between health plans and may exceed drug label requirements. This study aimed to characterize profiles and treatment history of patients with treatment-resistant depression (TRD) who initiated esketamine nasal spray, by stringency of their health plans' PA criteria relative to the esketamine label.

Adults with evidence of TRD (≥2 antidepressant courses of adequate dose and duration) prior to initiating esketamine were identified using US insurance claims data (03/2016-02/2022). Based on health plan PA criteria for esketamine obtained from Managed Markets Insight & Technology data (05/2020-02/2022), patients were grouped into stringent (PA criteria exceeds label) and non-stringent (PA criteria less stringent or equal to label) cohorts. Patient treatment history before esketamine initiation was compared using Wilcoxon rank sum and Fisher's exact tests.

The stringent cohort included 168 patients (mean age: 45 years, 63% female) and the non-stringent cohort included 400 patients (mean age: 45 years, 70% female). During the ongoing major depressive episode before esketamine initiation, the stringent versus non-stringent cohort completed 3.9 versus 3.8 antidepressant treatment courses, on average (p = 0.217); 94.6% versus 96.8% used augmentation therapy (p = 0.240), including 59.3% versus 58.1% with an antipsychotic (p = 0.844), respectively.

Regardless of health plan stringency, on average, patients exceeded US label-mandated number of antidepressant trials before esketamine initiation, which questions the need for health insurance plans PA criteria above label.