Comparative efficacy and acceptability of methylphenidate and atomoxetine in treatment of attention deficit hyperactivity disorder in children and adolescents: a meta-analysis

Abstract

BackgroundPsychostimulants and non stimulants are effective in the treatment of ADHD. Efficacy of both methylphenidate and atomoxetine has been established in placebo controlled trials. Direct comparison of efficacy is now possible due to availability of results from several head-to-head trials of these two medications.MethodsAll published, randomized, open label or double blind trials, comparing efficacy of methylphenidate with atomoxetine, in treatment of ADHD in children, diagnosed using DSM-IV™ criteria were included. The outcome studied was ADHDRS-IVParent:Inv score. The standardized mean difference (SMD) was used as a measure of effect size.ResultsNine randomized trials comparing methylphenidate and atomoxetine, with a total of 2762 participants were included. Meta-analysis did not find a significant difference in efficacy between methylphenidate and atomoxetine (SMD = 0.09, 95% CI -0.08-0.26) (Z = 1.06, p = 0.29). Synthesis of data from eight trials found no significant difference in response rates (RR = 0.93 95% CI 0.76-1.14, p = 0.49). Sub group analysis showed a significant standardized mean difference favouring OROS methylphenidate (SMD = 0.32, 95% CI 0.12-0.53 (Z = 3.05, p < 0.002). Immediate release methylphenidate was not superior to atomoxetine (SMD = -0.04, 95% CI -0.19-0.12) (Z = 0.46, p = 0.64). Excluding open label trials did not significantly alter the effect size (SMD = 0.08, 95% CI -0.04-0.21) (Z = 1.27, p = 0.20). All-cause discontinuation was used as a measure of acceptability. There was no significant difference in all cause discontinuation between atomoxetine and methylphenidate (RR 1.22, 95% CI 0.87-1.71). There was significant heterogeneity among the studies (p = 0.002, I2 = 67%). Subgroup analysis demonstrated the heterogeneity to be due to the open label trials (p = 0.001, I2 = 81%).ConclusionsIn general atomoxetine and methylphenidate have comparable efficacy and equal acceptability in treatment of ADHD in children and adolescents. However OROS methylphenidate is more effective than atomoxetine and may be considered as first line treatment in treatment of ADHD in children and adolescents.

A Systematic Review of Combination Therapy with Stimulants and Atomoxetine for Attention-Deficit/Hyperactivity Disorder, Including Patient Characteristics, Treatment Strategies, Effectiveness, and Tolerability

“…In addition to psychopharmacological treatment, nonpsychopharmacological interventions (e.g., behavior modification) are also required in most cases because of the complexity of ADHD symptoms and their diverse presentation (Hodgson et al 2012). Both stimulants and atomoxetine have been shown to be effective as monotherapy for the treatment of ADHD (Faraone et al 2006;Cheng et al 2007;Mészáros et al 2009;Faraone and Buitelaar 2010;Hanwella et al 2011). Although proven to be effective treatments, stimulant or atomoxetine monotherapy does not provide adequate coverage of symptoms in a small subset of patients (Spencer et al 1996;Newcorn et al 2008;Hazell et al 2011).…”

Neurobiological bases for impulsive and compulsive behaviour: Implications for pharmacological and psychological interventions

“…Stimulanti (metilfenidat, dekstroamfetamin) pogoršavaju agresivnost ali mogu biti efikasni kod ADHD [50].…”

Atomoxetine Versus Oros Methylphenidate in Attention Deficit Hyperactivity Disorder: A Six-Month Follow Up Study for Efficacy and Adverse Effects

“…One meta-analysis did not find any difference in terms of efficacy between IR MPH and ATX, but OROS-MPH was found more effective than ATX. 17 ATX and MPH (OROS-MPH and IR MPH) were found to have similar efficacies in another metaanalysis. 18 Another meta-analysis that included only the studies with follow up periods longer than 6 weeks did not find any difference between ATX and MPH (OROS-MPH and IR MPH).…”

“…9,10,12,14,15 The metaanalyses of those studies also show similar contradictions. [16][17][18][19] Therefore, there is still a need for the studies comparing MPH and ATX which are two agents frequently used in the treatment of ADHD. In addition, there is only one randomized comparison study performed on Turkish population on this topic.…”