CENTANAFADINE IN ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: PHARMACOLOGICAL INNOVATION WITHIN DIGITALLY MEDIATED AND STRUCTURALLY STRATIFIED HEALTH SYSTEMS
DOI:
https://doi.org/10.31435/ijitss.1(49).2026.5191Keywords:
Attention-Deficit/Hyperactivity Disorder, Centanafadine, Digital Health, Telepsychiatry, Health Systems Governance, Health EquityAbstract
Background: Attention-deficit/hyperactivity disorder (ADHD) represents a substantial clinical and socioeconomic burden worldwide, with significant direct and indirect costs and marked heterogeneity in pharmacotherapy use across healthcare systems (Chhibber et al., 2021, Dodds et al., 2024, Li et al., 2026). Simultaneously, ADHD care is increasingly delivered within digitally mediated infrastructures, including telepsychiatry and remote service models (Hubley et al., 2016, Myers et al., 2015, Torous et al., 2025).
Objective: This review evaluates centanafadine sustained-release (SR) as a pharmacological innovation in ADHD and examines its clinical evidence within the context of digital transformation, health system governance, and equity in access to care.
Methodology: A structured narrative review was conducted using peer-reviewed PubMed-indexed studies published between 2013 and 2026. The evidence base includes randomized controlled trials and long-term safety data for centanafadine (Adler et al., 2022, Mattingly et al., 2025, Ward et al., 2025, Wigal et al., 2020), indirect comparative analyses (Schein et al., 2024b), and studies addressing economic burden, regional prescribing variation, telehealth implementation, and documented racial, ethnic, and socioeconomic disparities in ADHD care (Akmatov et al., 2021, Coker et al., 2016, Ferrin et al., 2025, Gage et al., 2025, Ko et al., 2023, McKenna et al., 2024, Pearce et al., 2024).
Results: Clinical trials demonstrate statistically significant reductions in ADHD symptom severity in adults and adolescents treated with centanafadine SR, with an acceptable safety and tolerability profile supported by long-term exposure data (Adler et al., 2022, Mattingly et al., 2025, Ward et al., 2025, Wigal et al., 2020). Indirect comparative evidence situates centanafadine within the nonstimulant treatment landscape (Schein et al., 2024b). At the system level, ADHD remains associated with economic burden and heterogeneous prescribing patterns (Akmatov et al., 2021, Chhibber et al., 2021, Li et al., 2026). Digital service models demonstrate feasibility and clinical effectiveness in ADHD care (Hubley et al., 2016, Myers et al., 2015, Kurokawa et al., 2024), yet disparities in telehealth access and broader structural inequities continue to shape treatment utilization (Coker et al., 2016, Gage et al., 2025, Pearce et al., 2024).
Conclusion: Centanafadine expands the nonstimulant therapeutic portfolio in ADHD, however, its population-level impact will depend on how effectively it is integrated within digitally enabled care pathways, reimbursement frameworks, and equity-oriented governance structures. The alignment of pharmacological innovation with responsible digital implementation strategies may determine whether therapeutic expansion contributes to reducing or perpetuating existing inequalities in ADHD care (Claire et al., 2024, McKenna et al., 2024).
References
Adler, L. A., Adams, J., Madera-McDonough, J., Kohegyi, E., Hobart, M., Chang, D., Angelicola, M., McQuade, R., & Liebowitz, M. (2022). Efficacy, safety, and tolerability of centanafadine sustained-release tablets in adults with attention-deficit/hyperactivity disorder: Results of 2 phase 3, randomized, double-blind, multicenter, placebo-controlled trials. Journal of Clinical Psychopharmacology, 42(5), 429–439. https://doi.org/10.1097/JCP.0000000000001575
Akmatov, M. K., Holstiege, J., & Bätzing, J. (2021). Secular trends and regional variations in pharmacotherapy of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany. BMC Psychiatry, 21(1), 405. https://doi.org/10.1186/s12888-021-03409-6
Chhibber, A., Watanabe, A. H., Chaisai, C., Veettil, S. K., & Chaiyakunapruk, N. (2021). Global economic burden of attention-deficit/hyperactivity disorder: A systematic review. Pharmacoeconomics, 39(4), 399–420. https://doi.org/10.1007/s40273-020-00998-0
Claire, R., Elvidge, J., Hanif, S., Goovaerts, H., Rijnbeek, P. R., Jónsson, P., Facey, K., & Dawoud, D. (2024). Advancing the use of real-world evidence in health technology assessment: Insights from a multi-stakeholder workshop. Frontiers in Pharmacology, 14, 1289365. https://doi.org/10.3389/fphar.2023.1289365
Coker, T. R., Elliott, M. N., Toomey, S. L., Schwebel, D. C., Cuccaro, P., Tortolero Emery, S., Davies, S. L., Visser, S. N., & Schuster, M. A. (2016). Racial and ethnic disparities in ADHD diagnosis and treatment. Pediatrics, 138(3), e20160407. https://doi.org/10.1542/peds.2016-0407
Dodds, M., Wanni Arachchige Dona, S., Gold, L., Coghill, D., & Le, H. N. D. (2024). Economic burden and service utilization of children with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Value in Health, 27(2), 247–264. https://doi.org/10.1016/j.jval.2023.11.002
Ferrin, M., Häge, A., Swanson, J., Wong, K. H. T. W., Dittmann, R. W., Banaschewski, T., Coghill, D., Santosh, P. J., Romanos, M., Simonoff, E., & Buitelaar, J. K. (2025). Medication adherence and persistence in children and adolescents with attention deficit hyperactivity disorder (ADHD): A systematic review and qualitative update. European Child & Adolescent Psychiatry, 34(3), 867–882. https://doi.org/10.1007/s00787-024-02538-z
Gage, A. D., Knight, M. A., Bintz, C., Aldridge, R. W., Angelino, O., Dieleman, J. L., Ashworth Dirac, M., Dwyer-Lindgren, L., Hay, S. I., Lozano, R., Mokdad, A. H., & Haakenstad, A. (2025). Disparities in telemedicine use and payment policies in the United States between 2019 and 2023. Communications Medicine, 5(1), 52. https://doi.org/10.1038/s43856-025-00757-2
Galvin, E., Gavin, B., Kilbride, K., Desselle, S., McNicholas, F., Cullinan, S., & Hayden, J. (2024). The use of telehealth in attention-deficit/hyperactivity disorder: A survey of parents and caregivers. European Child & Adolescent Psychiatry, 33(12), 4247–4257. https://doi.org/10.1007/s00787-024-02466-y
Hodgkins, P., Setyawan, J., Mitra, D., Davis, K., Quintero, J., Fridman, M., Shaw, M., & Harpin, V. (2013). Management of ADHD in children across Europe: Patient demographics, physician characteristics and treatment patterns. European Journal of Pediatrics, 172(7), 895–906. https://doi.org/10.1007/s00431-013-1969-8
Hubley, S., Lynch, S. B., Schneck, C., Thomas, M., & Shore, J. (2016). Review of key telepsychiatry outcomes. World Journal of Psychiatry, 6(2), 269–282. https://doi.org/10.5498/wjp.v6.i2.269
Ko, J. S., El-Toukhy, S., Quintero, S. M., Wilkerson, M. J., Nápoles, A. M., & Strassle, P. D. (2023). Disparities in telehealth access, not willingness to use services, likely explain rural telehealth disparities. The Journal of Rural Health, 39(3), 617–624. https://doi.org/10.1111/jrh.12759
Kurokawa, S., Nomura, K., Hosogane, N., Nagasawa, T., Kawade, Y., Matsumoto, Y., Morinaga, S., Kaise, Y., Higuchi, A., Goto, A., Inada, N., Kodaira, M., & Kishimoto, T. (2024). Reliability of telepsychiatry assessments using the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV for children with neurodevelopmental disorders and their caregivers: Randomized feasibility study. Journal of Medical Internet Research, 26, e51749. https://doi.org/10.2196/51749
Li, X., Guo, Y., Giuliodori Picco, A., Palomar-Cros, A., Delmestri, A., Man, W. Y., Kaczmarczyk, I., Brash, J. T., Verhamme, K., Mosseveld, M., Duarte-Salles, T., Prieto-Alhambra, D., & Burn, E. (2026). Trends in use of attention-deficit hyperactivity disorder medications among children and adults in five European countries, 2010 to 2023: A population-based observational study. The Lancet Regional Health – Europe, 61, 101556. https://doi.org/10.1016/j.lanepe.2025.101556
Mattingly, G. W., Turkoglu, O., Chang, D., Ward, C., Skubiak, T., Zhang, Z., & Cutler, A. J. (2025). 52-week open-label safety and tolerability study of centanafadine sustained release in adults with attention-deficit/hyperactivity disorder. Journal of Clinical Psychopharmacology, 45(5), 454–462. https://doi.org/10.1097/JCP.0000000000002020
McKenna, K., Wanni Arachchige Dona, S., Gold, L., Dew, A., & Le, H. N. D. (2024). Barriers and enablers of service access and utilization for children and adolescents with attention deficit hyperactivity disorder: A systematic review. Journal of Attention Disorders, 28(3), 259–278. https://doi.org/10.1177/10870547231214002
Morgan, P. L., Staff, J., Hillemeier, M. M., Farkas, G., & Maczuga, S. (2013). Racial and ethnic disparities in ADHD diagnosis from kindergarten to eighth grade. Pediatrics, 132(1), 85–93. https://doi.org/10.1542/peds.2012-2390
Myers, K., Vander Stoep, A., Zhou, C., McCarty, C. A., & Katon, W. (2015). Effectiveness of a telehealth service delivery model for treating attention-deficit/hyperactivity disorder: A community-based randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 54(4), 263–274. https://doi.org/10.1016/j.jaac.2015.01.009
Pearce, A., Henery, P., Katikireddi, S. V., Dundas, R., Leyland, A. H., Nicholls, D., Viner, R. M., Fenton, L., & Hope, S. (2024). Childhood attention-deficit hyperactivity disorder: Socioeconomic inequalities in symptoms, impact, diagnosis and medication. Child and Adolescent Mental Health, 29(2), 126–135. https://doi.org/10.1111/camh.12707
Philippe, T. J., Sikder, N., Jackson, A., Koblanski, M. E., Liow, E., Pilarinos, A., & Vasarhelyi, K. (2022). Digital health interventions for delivery of mental health care: Systematic and comprehensive meta-review. JMIR Mental Health, 9(5), e35159. https://doi.org/10.2196/35159
Rzeszutek, M., & Wolańczyk, T. (2025). Global trends in ADHD medication use: Multiple contexts and rising concerns—A narrative review. Journal of Clinical Medicine, 14(20), 7338. https://doi.org/10.3390/jcm14207338
Schein, J., Cloutier, M., Gauthier-Loiselle, M., Catillon, M., Meng, Y., Libchaber, B., Jiang, F., & Childress, A. (2024a). Treatment preferences of adult patients with attention-deficit/hyperactivity disorder: A discrete choice experiment. Patient Preference and Adherence, 18, 1651–1664. https://doi.org/10.2147/PPA.S467724
Schein, J., Cloutier, M., Gauthier-Loiselle, M., Catillon, M., Xu, C., Chan, D., & Childress, A. (2024b). Assessment of centanafadine in adults with attention-deficit/hyperactivity disorder: A matching-adjusted indirect comparison vs lisdexamfetamine dimesylate, atomoxetine hydrochloride, and viloxazine extended-release. Journal of Managed Care & Specialty Pharmacy, 30(6), 528–540. https://doi.org/10.18553/jmcp.2024.30.6.528
Sharma, M., Sharma, V., & Peeples, D. (2025). Telepsychiatry, access, and equity: Accelerating mental health care for rural and low-income youth. Frontiers in Public Health, 13, 1698682. https://doi.org/10.3389/fpubh.2025.1698682
Shende, V., & Wagh, V. (2024). Role of telemedicine and telehealth in public healthcare sector: A narrative review. Cureus, 16(9), e69102. https://doi.org/10.7759/cureus.69102
Torous, J., Linardon, J., Goldberg, S. B., Sun, S., Bell, I., Nicholas, J., Hassan, L., Hua, Y., Milton, A., & Firth, J. (2025). The evolving field of digital mental health: Current evidence and implementation issues for smartphone apps, generative artificial intelligence, and virtual reality. World Psychiatry, 24(2), 156–174. https://doi.org/10.1002/wps.21299
Ward, C. L., Childress, A. C., Jin, N., Turkoglu, O., Skubiak, T., & Wilens, T. E. (2025). Centanafadine for attention-deficit/hyperactivity disorder in adolescents: A randomized clinical trial. Journal of the American Academy of Child & Adolescent Psychiatry. Advance online publication. https://doi.org/10.1016/j.jaac.2025.06.023
Wigal, S. B., Wigal, T., Hobart, M., Madera, J. J., Baker, R. A., Kohegyi, E., McKinney, A., & Wilens, T. E. (2020). Safety and efficacy of centanafadine sustained-release in adults with attention-deficit hyperactivity disorder: Results of phase 2 studies. Neuropsychiatric Disease and Treatment, 16, 1411–1426. https://doi.org/10.2147/NDT.S242084
Yang, K. G., Flores, M. W., Carson, N. J., & Cook, B. L. (2022). Racial and ethnic disparities in childhood ADHD treatment access and utilization: Results from a national study. Psychiatric Services, 73(12), 1338–1345. https://doi.org/10.1176/appi.ps.202100578
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Copyright (c) 2026 Karolina Krawczyk, Karolina Magda Leszczyńska, Anna Krzysztofik, Jeremi Leon Jasiński, Maciej Tomasz Wieczorek, Weronika Napierała, Aleksandra Maria Tomaszewska, Alicja Maria Mitan, Karolina Julia Hak, Kamila Teresa Kańska
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