New ADHD Medications Allow For More Personalized Treatment Plans

In this video, Andrew J. Cutler, MD, discusses the newer medications in development and recently approved to treat attention attention-deficit/hyperactivity disorder (ADHD). It is “a very exciting time” as there are a number of newer treatment options, allowing clinicians to personalize treatment for their patients with ADHD, said Dr. Cutler, who is an associate professor of psychiatry at SUNY Upstate Medical University, Syracuse, New York.

Dr. Cutler also discusses viloxazine extended-release capsules, or Qelbree, recently approved by the Food and Drug Administration (FDA) for the treatment of ADHD in children and adolescents aged 6-17 which is now available in pharmacies.

Read the Transcript:

Hello. I'm Dr. Andrew Cutler, clinical associate professor of psychiatry at SUNY Upstate Medical University, Syracuse, New York. Today, I'm excited to be talking to you about newer treatments for ADHD. 

I've been doing clinical trials and research in ADHD for over 20 years. Really, this is one of the most exciting times that I've seen as far as newer developments. We have, of course, the stimulants which are considered the first-line treatment for ADHD for both children and adults. 

Over the past few years, there have been quite a few new formulations of stimulants. Basically, the stimulants are divided into 2. There's the methylphenidate, the so-called “Ritalin group”, and the amphetamines, or the so-called “Adderall group”. 

All of the medications that have been developed in the past 20 years have been newer formulations: either new or time-release, extended-release technologies, or newer ways to get the medication into the bloodstream if somebody can't or won't swallow a pill. 

Recently, we've had a newer stimulant medication approved. It's a combination of serdexmethylphenidate which is a methylphenidate prodrug, similar to lisdexamfetamine, known as Vyvanse, which is an amphetamine prodrug.

But what they've done is combined it with some immediate release dexmethylphenidate, so you get the immediate-release, theoretically, the relatively quick onset of action. Then the serdexmethylphenidate begins releasing, and you get the extended-release/all-day coverage. That's been FDA-approved now. The brand name is Azstarys.

Now, a really exciting area of development has been in the non-stimulants or the non-scheduled medications. There were only three FDA-approved until recently, and that would be atomoxetine/Strattera, extended-release guanfacine or Intuniv, and extended-release clonidine or Kapvay. The last of those were approved over 10 years ago. 

We recently had viloxazine extended-release approved. The brand name is Qelbree. This is very exciting because this is a non-stimulant medication that has demonstrated efficacy as early as one week after starting the treatment. 

It has shown efficacy not only on the overall symptoms of ADHD but also equal efficacy for both the inattentive symptoms and the hyperactive impulsive symptoms. Finally, it comes in a capsule that can be opened and sprinkled onto applesauce, and it's approved for children and adolescents at this point. 

For children or adolescents who can't swallow or don't want to swallow pills, it's the only non-stimulant that you can do that with. There is another non-stimulant in development called centanafadine, which is a triple reuptake inhibitor, increasing norepinephrine, dopamine, and serotonin. 

It's a very exciting time. There's a lot of newer options that gives us the opportunity as clinicians to individualize our treatment for our patients with ADHD. One of the misconceptions here is that a medication is not appropriate or should not be used. Another misconception is that we're either over or underdiagnosing ADHD.

I think that we really have an issue more with the underdiagnosis, under recognition, and inappropriate or inadequate treatment, so it's wonderful to have these tools. Thank you.

Andrew J. Cutler, MD is the Chief Medical Officer at Neuroscience Education Institute, Carlsbad, California, and a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University, Syracuse, New York.  He holds a BS in Biology from Haverford College, and obtained his medical degree from the University of Virginia School of Medicine, Charlottesville, Virginia. Dr. Cutler completed his medical internship and residencies in both Internal Medicine and Psychiatry at the University of Virginia Health Sciences Center. He is board certified in Internal Medicine by the American Board of Internal Medicine and in Psychiatry by the American Board of Psychiatry and Neurology.  He is also a Certified Physician Investigator (CPI) by the Association of Clinical Research Professionals (ACRP).

Dr. Cutler has been conducting clinical research since 1993, and has been a Principal Investigator on over 400 clinical trials in a variety of CNS and medical indications. He has authored more than 100 peer-reviewed scientific articles and has presented more than 300 abstracts and posters at scientific meetings around the world.  He is a peer reviewer for several prominent medical journals and has served on several editorial boards.

Dr. Cutler is a member of the American Psychiatric Association (APA), the Florida Psychiatric Society (FPS) and the American Medical Association (AMA).

Reference

Qelbree™ (viloxazine extended-release capsules), a new non-controlled substance, now available for the treatment of adhd in pediatric patients 6-17 years of age. [press release]. Rockville, MD: Supernus Pharmaceuticals, Inc.; May 24, 2021.