Clinical trial NCT02536105: PK/PD Pediatric ADHD Classroom Study
Official title: Pharmacokinetic Pharmacodynamic Studies of Methylphenidate Extended Release Products in Pediatric Attention Deficit Hyperactivity Disorder
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Attention Deficit Hyperactivity Disorder
Keywords: Attention Deficit Hyperactivity Disorder
ADHD
Lead sponsor: Massachusetts General Hospital
Sponsor class: OTHER
Collaborators: name: Food and Drug Administration (FDA)
name: Center for Psychiatry And Behavioral Medicine Inc.
First posted: 2015-08-31
Enrollment: 88
Sex: ALL
Minimum age (years): 6
Maximum age (years): 12
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to evaluate the association between blood drug levels and the corresponding scores of commonly used behavioral instruments based upon data collected following administration of three different methylphenidate hydrochloride extended-release drug products in children with ADHD.

Detailed description: This is a randomized, double-blind, 4-treatment and 4-period crossover study conducted in a school laboratory environment to evaluate the hour-by-hour behavioral instrument scores and hour-by-hour PK of 3 different extended-release MPH formulations as well as placebo in children with ADHD. The complete study consists of three periods: Screening, Dose Titration and Double-Blind Crossover in a Laboratory Classroom.

The double-blind phase will consist of four periods (or four weeks): each week will consist of blinded administration with one of the three active methylphenidate hydrochloride treatments or placebo from Sunday through Saturday. On the last day of each period (Saturday), study participants will be evaluated in a laboratory classroom setting. On Saturdays, the blinded doses of each study drug will be administered at the school site by study staff on the morning of the test laboratory classroom day. On the other days, the medication will be taken in the morning at home.

Eligibility criteria: Inclusion Criteria:

1. Male and female outpatients
2. Ages 6-12 years at time of screening
3. Judged by the investigator to be physically healthy and suitable for participation in the study
4. Diagnosis of DSM-5ADHD combined, predominantly inattentive or hyperactive/impulsive presentation, per clinical evaluation and confirmed by the MINI-KID
5. Clinical Global Impressions-Severity (CGI-S) ≥ 3
6. ≥ 90th percentile normative value for gender and age on the ADHD RS-IV total score at screening or baseline
7. Study participant has a parent/legal guardian who is willing and able to give written informed consent for him/her to participate in the study
8. Study participant must be able to give assent to participate in the trial
9. Study participant and legal guardian must be able to speak and understand English
10. Able to tolerate multiple finger pricks
11. Willing to comply with all study procedures

Exclusion Criteria:

1. Current (last month) psychiatric diagnosis other than specific phobia, motor skills disorders, oppositional defiant disorder, sleep disorders, elimination disorders, adjustment disorders, learning disorders, or communication disorders. Participants with school phobia or separation anxiety will not be eligible
2. Cognitively impaired, in the investigator's opinion
3. Any clinically significant chronic medical condition that, in the judgment of the investigator, may interfere with the participant's ability to participate in the study
4. Seizure disorder excluding a history of febrile seizures
5. Thyroid disease
6. Tourette's disorder or chronic tic disorder (mild medication induced tics are allowed)
7. Serious cardiac condition including cardiomyopathy, serious arrhythmias, structural cardiac disorders, or severe hypertension
8. Glaucoma
9. Current or recent (within the past 6 months) DSM-5 drug dependence or substance abuse (excluding nicotine and caffeine)
10. Pregnant or nursing females. Females must have a negative urine pregnancy test at screening as well as four additional visits and must be abstinent or use adequate and reliable contraception throughout the study
11. Currently treated and satisfied with ADHD medication
12. Current psychotropic medications other than sedative hypnotics for sleep
13. Use of atomoxetine, clonidine, guanfacine or a monoamine oxidase inhibitor within 28 days of the baseline visit
14. Participation in another investigational medication study within 30 days prior to screening
15. Clinically significant abnormal laboratory result, electrocardiogram (ECG) result, physical examination, or vital signs at screening that the investigator considers to be inappropriate to allow participation in the study
16. Planned use of prohibited drugs from the baseline visit through the end of the trial
17. History of allergic reaction or a known or suspected sensitivity to any substance that is contained in the study drugs
18. Food allergies that are determined by the PI as too severe to be easily accommodated for during the study
19. Inability to swallow study medication

Primary outcomes:
measure: Permanent Product Measure of Performance (PERMP) for Three Methylphenidate Hydrochloride Extended-release Drug Products
timeFrame: 0.5, 1.5, 2.5, 4, 5, 6, 8, 10 and 12 hours post-dose on each classroom day
measure: Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) Rating Scale for Three Methylphenidate Hydrochloride Extended-release Drug Products
timeFrame: 0.5, 1.5, 2.5, 4, 5, 6, 8, 10 and 12 hours post-dose on each classroom day
measure: Maximum Drug Concentration Observed (Cmax) for Three Methylphenidate Hydrochloride Extended-release Drug Products
timeFrame: 0.5, 1.5, 2.5, 4, 5, 6, 8, and 12 hours post-dose on each classroom day
measure: Time to Reach Cmax (Tmax) for Three Methylphenidate Hydrochloride Extended-release Drug Products
timeFrame: 0.5, 1.5, 2.5, 4, 5, 6, 8, and 12 hours post-dose on each classroom day
Secondary outcomes:
Other outcomes:
Locations:
city: Boston
country: United States
facility: Massachusetts General Hospital
state: Massachusetts
city: Las Vegas
country: United States
facility: Center for Psychiatry and Behavioral Medicine
state: Nevada
Study officials:
affiliation: Massachusetts General Hospital
name: Thomas Spencer, MD
role: PRINCIPAL_INVESTIGATOR
References: