| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 1.2 MB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
A perturbação de hiperatividade com défice de atenção (ADHD, do inglês attention deficit hyperactivity disorder) é uma das patologias neurológicas mais prevalentes em pediatria, caracterizando-se por sintomas de inatenção e hiperatividade e/ou impulsividade que conduzem a impedimentos sociais, académicos e profissionais. Compostos ativos derivados da anfetamina como o metilfenidato constituem a terapia farmacológica de primeira linha, devido à sua elevada eficácia na atenuação deste distúrbio. Contudo, limitações tais como efeitos adversos, a potencialização de comorbidades e contraindicações em determinados indivíduos tornam necessária a disponibilidade de alternativas farmacológicas. Alternativas como a atomoxetina e fármacos não estimulantes, como a guanfacina e clonidina, são utilizados como tratamento de segunda linha, no entanto demonstram eficácia inferior e latência de várias semanas no início de ação. Este trabalho de dissertação tem como objetivos a compilação das terapias farmacológicas atualmente aprovados para o tratamento da ADHD, assim como a apresentação de fármacos recentemente aprovados e/ou em desenvolvimento. O trabalho procura comparar estes fármacos quanto ao seu efeito terapêutico, perfil de segurança, e tolerabilidade, de forma a avaliar a possibilidade de uma futura alteração na farmacoterapia deste distúrbio. O desenvolvimento de novos fármacos como a centanafadina e a aprovação da viloxazina para o tratamento deste distúrbio pela FDA refletem o crescente interesse no papel da neurotransmissão serotoninérgica, no controlo da atenção, impulsividade, e regulação emocional. A viloxazina demonstra uma eficácia terapêutica semelhante a outros fármacos de segunda linha, com um perfil de segurança mais favorável comparativamente à atomoxetina. Ensaios clínicos recentes demonstram que a centanafadina apresenta um efeito terapêutico semelhante ao metilfenidato em adultos, com melhor tolerabilidade. No entanto, ensaios comparando estes fármacos diretamente são necessários de forma a aferir sobre os seus efeitos em pediatria a longo prazo. Por outro lado, a aprovação recente da associação serdexmetilfenidato/dexmetilfenidato pela FDA representa uma alternativa de toma única diária a formulações de libertação prolongada de metilfenidato, com um início de ação rápido (30 minutos) e um efeito com uma duração mais prolongada de 13 horas. Palavras-chave: Perturbação de hiperatividade com défice de atenção; Farmacoterapia; Neurofarmacologia; Metilfenidato.
Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent neurological conditions in pediatrics, characterized by symptoms of inattention, and hyperactivity and/or impulsivity that lead to social, academic, and professional impairments. Amphetamine-derived compounds such as methylphenidate are considered the first-line pharmacological therapy due to their high efficacy in reducing symptoms of this disorder. However, limitations such as adverse effects, exacerbation of comorbidities and contraindications in certain patients make alternative treatments necessary. Alternative pharmacological options such as atomoxetine, and non-stimulants such as guanfacine and clonidine are used as second-line treatments but show lower efficacy and a delayed onset of action, often requiring weeks. This dissertation work has the objectives of compiling the currently approved pharmacological treatments for ADHD, as well as presenting newly approved and/or in development drugs. This work aims to compare their therapeutic effect, safety profile, and tolerability, in order to evaluate the possibility of a future change in the pharmacotherapy of this disorder. The development of novel drugs such as centanafadine and the FDA-approved viloxazine for ADHD treatment reflect the growing interest in the role of serotoninergic neurotransmission in the regulation of attention, impulsivity, and emotional control. Viloxazine has demonstrated therapeutic efficacy comparable to other second-line agents, with a more favorable safety profile than atomoxetine. In comparison to methyphenidate, clinical trials have shown that higher doses of centanafadine produce a similar reduction of symptoms after 4 weeks in adults, with a more favorable short-term safety profile. Nonetheless, the lack of direct head-to-head pediatric trials and the need for long-term safety evaluations limit definitive conclusions. Furthermore, the recently FDA-approved serdexmethylphenidate/dexmethylphenidate combination provides a true once daily alternative to extended-release methylphenidate formulations, with a rapid onset of action (30 minutes) and a longer therapeutic duration of up to 13 hours.
Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent neurological conditions in pediatrics, characterized by symptoms of inattention, and hyperactivity and/or impulsivity that lead to social, academic, and professional impairments. Amphetamine-derived compounds such as methylphenidate are considered the first-line pharmacological therapy due to their high efficacy in reducing symptoms of this disorder. However, limitations such as adverse effects, exacerbation of comorbidities and contraindications in certain patients make alternative treatments necessary. Alternative pharmacological options such as atomoxetine, and non-stimulants such as guanfacine and clonidine are used as second-line treatments but show lower efficacy and a delayed onset of action, often requiring weeks. This dissertation work has the objectives of compiling the currently approved pharmacological treatments for ADHD, as well as presenting newly approved and/or in development drugs. This work aims to compare their therapeutic effect, safety profile, and tolerability, in order to evaluate the possibility of a future change in the pharmacotherapy of this disorder. The development of novel drugs such as centanafadine and the FDA-approved viloxazine for ADHD treatment reflect the growing interest in the role of serotoninergic neurotransmission in the regulation of attention, impulsivity, and emotional control. Viloxazine has demonstrated therapeutic efficacy comparable to other second-line agents, with a more favorable safety profile than atomoxetine. In comparison to methyphenidate, clinical trials have shown that higher doses of centanafadine produce a similar reduction of symptoms after 4 weeks in adults, with a more favorable short-term safety profile. Nonetheless, the lack of direct head-to-head pediatric trials and the need for long-term safety evaluations limit definitive conclusions. Furthermore, the recently FDA-approved serdexmethylphenidate/dexmethylphenidate combination provides a true once daily alternative to extended-release methylphenidate formulations, with a rapid onset of action (30 minutes) and a longer therapeutic duration of up to 13 hours.
Descrição
Palavras-chave
Perturbação de hiperatividade com défice de atenção Farmacoterapia Neurofarmacologia Metilfenidato