Comparative efficacy and acceptability of atomoxetine, lisdexamfetamine, bupropion and methylphenidate in treatment of attention deficit hyperactivity disorder in children and adolescents: A meta-analysis with focus on bupropion

Štuhec, Matej; Munda, B.; Švab, Vesna; Locatelli, Igor

doi:10.1016/j.jad.2015.03.006

Cited by 68 publications

(59 citation statements)

References 49 publications

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“…Along with broad recognition that data from some clinical trials and treatment comparisons were sparse, and that more and higher-quality data could improve estimations and recommendations, aspects of the general approach of previous systematic reviews and meta-analyses [12–17,81–83] were challenged. For example, two recent Cochrane systematic reviews have suggested that stimulants such as amphetamines [12] and methylphenidate [13] may improve ADHD core symptoms compared to placebo (or no intervention) in children and adolescents; but overall quality of the evidence ranged from low to very low on most outcomes.…”

Section: Discussionmentioning

confidence: 99%

The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials

et al. 2017

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BackgroundAttention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed psychiatric disorders in childhood. A wide variety of treatments have been used for the management of ADHD. We aimed to compare the efficacy and safety of pharmacological, psychological and complementary and alternative medicine interventions for the treatment of ADHD in children and adolescents.Methods and findingsWe performed a systematic review with network meta-analyses. Randomised controlled trials (≥ 3 weeks follow-up) were identified from published and unpublished sources through searches in PubMed and the Cochrane Library (up to April 7, 2016). Interventions of interest were pharmacological (stimulants, non-stimulants, antidepressants, antipsychotics, and other unlicensed drugs), psychological (behavioural, cognitive training and neurofeedback) and complementary and alternative medicine (dietary therapy, fatty acids, amino acids, minerals, herbal therapy, homeopathy, and physical activity). The primary outcomes were efficacy (treatment response) and acceptability (all-cause discontinuation). Secondary outcomes included discontinuation due to adverse events (tolerability), as well as serious adverse events and specific adverse events. Random-effects Bayesian network meta-analyses were conducted to obtain estimates as odds ratios (ORs) with 95% credibility intervals. We analysed interventions by class and individually. 190 randomised trials (52 different interventions grouped in 32 therapeutic classes) that enrolled 26114 participants with ADHD were included in complex networks. At the class level, behavioural therapy (alone or in combination with stimulants), stimulants, and non-stimulant seemed significantly more efficacious than placebo. Behavioural therapy in combination with stimulants seemed superior to stimulants or non-stimulants. Stimulants seemed superior to behavioural therapy, cognitive training and non-stimulants. Behavioural therapy, stimulants and their combination showed the best profile of acceptability. Stimulants and non-stimulants seemed well tolerated. Among medications, methylphenidate, amphetamine, atomoxetine, guanfacine and clonidine seemed significantly more efficacious than placebo. Methylphenidate and amphetamine seemed more efficacious than atomoxetine and guanfacine. Methylphenidate and clonidine seemed better accepted than placebo and atomoxetine. Most of the efficacious pharmacological treatments were associated with harms (anorexia, weight loss and insomnia), but an increased risk of serious adverse events was not observed. There is lack of evidence for cognitive training, neurofeedback, antidepressants, antipsychotics, dietary therapy, fatty acids, and other complementary and alternative medicine. Overall findings were limited by the clinical and methodological heterogeneity, small sample sizes of trials, short-term follow-up, and the absence of high-quality evidence; consequently, results should be interpreted with caution.ConclusionsClinical differences may exist between the ph...

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Section: Discussionmentioning

confidence: 99%

The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials

et al. 2017

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“…16 17 Their findings have generated an intense debate in the field regarding interpretation of the degree of bias involved in trials sponsored by the pharmaceutical industry. [18][19][20][21][22][23] To better assess the benefits of treatments, longitudinal clinical effectiveness trials that include patients with co-existing disorders (such as those seen in most clinic settings) are warranted.…”

Section: Adhd Factsmentioning

confidence: 99%

Stimulant medication to treat attention-deficit/hyperactivity disorder

Santosh

2017

BMJ

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“…The Medical Letter , a publication described by the then deputy editor of the New England Journal of Medicine as producing “prescribing recommendations that are free of pharmaceutical influence” (Zuccotti in Valentino, 2004), reported of Vyvanse that, it “has no euphoric effects if given IV [intravenously] or taken intranasally and is thought to have less potential for abuse than amphetamine itself. The duration of action of lisdexamfetamine (Vyvanse) is longer than that of other amphetamine preparations, which may be an advantage for use in working adults.” Vyvanse’s advantages over other medications in its class have also been established in two meta-analyses that synthesized the results of 32 (Roskell et al, 2014) and 28 clinical trials (Stuhec et al, 2015), respectively. As Stuhec et al (2015) wrote, “The results suggest that lisdexamfetamine [Vyvanse] has the best benefit risk balance and has promising potential for treating children and adolescents with ADHD.”…”

Section: Introductionmentioning

confidence: 99%

“…The duration of action of lisdexamfetamine (Vyvanse) is longer than that of other amphetamine preparations, which may be an advantage for use in working adults.” Vyvanse’s advantages over other medications in its class have also been established in two meta-analyses that synthesized the results of 32 (Roskell et al, 2014) and 28 clinical trials (Stuhec et al, 2015), respectively. As Stuhec et al (2015) wrote, “The results suggest that lisdexamfetamine [Vyvanse] has the best benefit risk balance and has promising potential for treating children and adolescents with ADHD.”…”

Section: Introductionmentioning

confidence: 99%

Gifts and influence: Conflict of interest policies and prescribing of psychotropic medications in the United States

King

Bearman

2017

Social Science & Medicine

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The pharmaceutical industry spends roughly 15 billion dollars annually on detailing – providing gifts, information, samples, trips, honoraria and other inducements – to physicians in order to encourage them to prescribe their drugs. In response, several states in the United States adopted policies that restrict detailing. Some states banned gifts from pharmaceutical companies to doctors, other states simply required physicians to disclose the gifts they receive, while most states allowed unrestricted detailing. We exploit this geographic variation to examine the relationship between gift regulation and the diffusion of four newly marketed medications. Using a dataset that captures 189 million psychotropic prescriptions written between 2005 and 2009, we find that uptake of new costly medications was significantly lower in states with marketing regulation than in areas that allowed unrestricted pharmaceutical marketing. In states with gift bans, we observed reductions in market shares ranging from 39% to 83%. Policies banning or restricting gifts were associated with the largest reductions in uptake. Disclosure policies were associated with a significantly smaller reduction in prescribing than gift bans and gift restrictions. In states that ban gift-giving, peer influence substituted for pharmaceutical detailing when a relatively beneficial drug came to market and provided a less biased channel for physicians to learn about new medications. Our work suggests that policies banning or limiting gifts from pharmaceutical representatives to doctors are likely to be more effective than disclosure policies alone.

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Comparative efficacy and acceptability of atomoxetine, lisdexamfetamine, bupropion and methylphenidate in treatment of attention deficit hyperactivity disorder in children and adolescents: A meta-analysis with focus on bupropion

Cited by 68 publications

References 49 publications

The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials

The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials

Stimulant medication to treat attention-deficit/hyperactivity disorder

Gifts and influence: Conflict of interest policies and prescribing of psychotropic medications in the United States

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