Reviewing the role of emerging therapies in the ADHD armamentarium

ABSTRACT

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder that can be treated with both pharmacologic and nonpharmacologic modalities. Effective drug treatments for ADHD have been available for more than six decades. However, initial treatments had limitations in duration of effect, need for multiple daily doses, requirement for patients to swallow intact tablets, adverse effects and risk for abuse and diversion. During the past 20 years, more than two dozen stimulant and nonstimulant drugs have been developed. Nonetheless, there remain unmet needs in the treatment of ADHD.

Areas covered: New stimulant and nonstimulant formulations in development are reviewed with emphasis on drugs in phase II and III trials. Efficacy, mechanism of action and adverse effect data are described where available. Abuse liability studies are described for abuse-deterrent formulations in development.

Expert opinion: The review found a robust pipeline of stimulants and nonstimulants. Medications in development are formulated to optimize onset and duration of effect, alter the time of administration, obviate the need to swallow whole capsules or tablets and to deter abuse. While each of these formulations may fill a unique niche, these incremental improvements based on new drug delivery technologies may lead to very significant clinical effects.

KEYWORDS:

• Attention-deficit/hyperactivity disorder
• ADHD
• stimulants
• amphetamine
• methylphenidate
• nonstimulants

Declaration of interest

Ann Childress has received research support, writing support, has participated in advisory boards, or been a consultant and/or speaker for Allergan, Emalex Biosciences, Takeda, Lundbeck, Pearson, Akili Interactive, Arbor Pharmaceuticals, Cingulate Therapeutics, Ironshore Pharmaceuticals, Forest Laboratories, Aevi Genomic Medicine, Neos Therapeutics, Neurovance, Otsuka, Pfizer, Purdue Pharma, Adlon Therapeutics, Rhodes Pharmaceuticals, Servier, Sunovion, Tris Pharma, KemPharm, Supernus Pharmaceuticals, NLS Pharma and Jazz Pharmaceuticals. She also is the recipient of a U.S. Food and Drug Administration Grant.

Margaret Weiss has received travel support, hornoraria or consulting fees from Eunethydis, Word Federation of ADHD, Mundipharma, Purdue Canada, Purdue U.S., Akili, Multi-Health Systems, NLS Pharma, Takeda, Rhodes, Huron Consulting and Global Medical Education. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they are a consultant to Takeda, Ironshore, Supernus, and Sunovion and receive royalties from Yale University Press, American Psychiatric Publishing, Routledge, Jossey-Bass/Wiley, Pearson. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.