Guanfacine Is Ineffective for Children's Chronic Tic Disorders

Summary and Comment |
August 8, 2017

Guanfacine Is Ineffective for Children's Chronic Tic Disorders

  1. Barbara Geller, MD

Improvement in tics was similar with extended-release guanfacine and placebo in children with moderate-to-severe symptoms.

  1. Barbara Geller, MD

These researchers conducted a pilot, manufacturer-supported, multisite, double-blind, placebo-controlled 8-week trial to ascertain whether extended-release guanfacine would be effective for chronic tics of moderate or greater global severity and thus warrant a larger trial.

The 34 child participants had a mean age of 11 years (range, 6–17; 68% boys). Stable medication was allowed. Guanfacine and placebo groups did not significantly differ on comorbidity with attention-deficit/hyperactivity disorder (ADHD; 50% vs. 22%) or obsessive-compulsive disorder (19% vs. 17%). Mean XR-guanfacine dose was 2.6 mg.

No significant differences between XR-guanfacine and placebo occurred on the primary measure of tic severity or on a global measure of improvement. Over 75% of children on XR-guanfacine, compared with 17% on placebo, sustained tiredness/fatigue or drowsiness, a highly significant difference. XR-guanfacine improved ADHD symptoms, with a medium effect size.

Comment

This study's negative findings do not support embarking on a larger multisite trial. Two previous studies that included only children with mild tics had mixed results (Clin Neuropharmacol 2002; 25:325 and Am J Psychiatry 2001; 158:1067).

Despite the paucity of data supporting guanfacine, it is included in the American Academy of Child and Adolescent Psychiatry Practice Parameters for Tic Disorders (J Am Acad Child Adolesc Psychiatry 2013; 52:1341). Clinicians have an understandable interest in alternatives to antipsychotics for children with tic disorders unresponsive to nonpharmacological therapies, because of metabolic and neurological adverse drug effects. Nevertheless, negative studies suggest caution in prescribing guanfacine for tics, especially given the learning decrements that can occur in drowsy, sedated children.

Editor Disclosures at Time of Publication

  • Disclosures for Barbara Geller, MD at time of publication Nothing to disclose

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