Amélioration de l’usage des psychostimulants en TDAH pédiatrique par des régimes médicamenteux axés sur le bien-être des patients : approche par modélisation et simulation
Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder known mostly for school-aged children, but as well diagnosed in adulthood. People with ADHD often have trouble in paying attention, or difficulty in controlling impulsive behaviors, or being overly active. Worldwide it has been reported a prevalence between 5.29% and 7.1% in children and adolescents. Psychostimulants, mainly methylphenidate (MPH), are used in extended release (ER) and immediate release (IR) formulations from different pharmaceutical companies. Using clinical and statistical criteria, this study aims to present a quantitive strategy for better combined use of these medications, while respecting a patient’s specific needs. Using our population pharmacokinetic models of various formulations of MPH with data in hand, we generalized our previously developped computational strategy to IR MPH in the case of combination use of IR and ER. It consists of three steps: a clinical selection process at first, followed by a statistical comparison process (mean, ratio and variance), and the detailed computation around the regime performance distribution as the last step to provide additional information on the comparison. A combination regimen of ER and IR formulations performs better than a t.i.d. of IR formulations, with a probability of 50.1% that the combination will outperform the t.i.d. regimen by a difference larger than 10% in the morning. The combination also outperforms a q.d. ER dosing regimen, with a difference larger than 10% in the morning for 47.1% of simulated patients. Using this algorithm, we are able to adapt the use of psychostimulant drugs to a patient, accounting for his daily routine and activities.
ADHD methylphenidate comparison regimen combination