Long-acting versus short-acting methylphenidate for paediatric ADHD: a systematic review and meta-analysis of comparative efficacy

Abstract

ObjectiveTo synthesise existing knowledge of the efficacy and safety of long-acting versus short-acting methylphenidate for paediatric attention deficit hyperactivity disorder (ADHD).DesignSystematic review and meta-analysis.Data sourcesElectronic literature search of CENTRAL, MEDLINE, PreMEDLINE, CINAHL, EMBASE, PsychINFO, Scopus and Web of Science for articles published in the English language between 1950 and 2012. Reference lists of included studies were checked for additional studies.Study selectionRandomised controlled trials of paediatric ADHD patients (<18 years), comparing a long-acting methylphenidate form to a short-acting methylphenidate form.Data extractionTwo authors independently selected trials, extracted data and assessed risk of bias. Continuous outcomes were compared using standardised mean differences (SMDs) between treatment groups. Adverse events were compared using risk differences between treatment groups. Heterogeneity was explored by subgroup analysis based on the type of long-acting formulation used.ResultsThirteen RCTs were included; data from 882 participants contributed to the analysis. Meta-analysis of three studies which used parent ratings to report on hyperactivity/impulsivity had an SMD of −0.30 (95% CI −0.51 to −0.08) favouring the long-acting forms. In contrast, three studies used teacher ratings to report on hyperactivity and had an SMD of 0.29 (95% CI 0.05 to 0.52) favouring the short-acting methylphenidate. In addition, subgroup analysis of three studies which used parent ratings to report on inattention/overactivity indicate that the osmotic release oral system generation long-acting formulation was favoured with an SMD of −0.35 (95% CI −0.52 to −0.17), while the second generation showed less efficacy than the short-acting formulation with an SMD of 0.42 (95% CI 0.17 to 0.68). The long-acting formulations presented with slightly more total reported adverse events (n=578) as compared with the short-acting formulation (n=566).ConclusionsThe findings from this systematic review indicate that the long-acting forms have a modest effect on the severity of inattention/overactivity and hyperactivity/impulsivity according to parent reports, whereas the short-acting methylphenidate was preferred according to teacher reports for hyperactivity.

Effects of methylphenidate on executive functioning in attention-deficit/hyperactivity disorder across the lifespan: a meta-regression analysis

“…In the current study, we will, therefore, focus on those functions that are known to be often compromised in ADHD and have been sufficiently studied in the context of MPH effects to conduct a meta-regression analysis. Although not previously addressed in meta-analyses regarding the effects of MPH on executive functioning, previous research has shown that medication naivety (Schwartz & Correll, 2014), dosage (Tannock et al 1995;Konrad et al 2004Konrad et al , 2005 and MPH formulation (Punja et al 2013) are additional potential moderators of the effects of stimulants. Shiels et al 2009;Luman et al 2015).…”

Preference for Distinct Functional Conformations of the Dopamine Transporter Alters the Relationship between Subjective Effects of Cocaine and Stimulation of Mesolimbic Dopamine

“…We assessed the cocaine-like discriminative-stimulus effects of three cocaine-like DUIs, cocaine, its analogWIN35,428, and methylphenidate (an FDA-approved medication for treatment of attention deficit hyperactivity disorders, ADHD) (19). Each of these compounds has been shown to preferentially bind the outward facing conformation of the DAT (13, 20, 21).…”

Brief report of efficacy and side effect profile of crossing over to modified-release capsules of methylphenidate in ADHD patients receiving other treatments: case series

“…Nevertheless, we observed similar responses to treatment while there were substantially more side effects in patients using OROS-MPH. The findings of a recent review, which considers studies comparing IR-and ER-MPH formulations, indicated that long-acting forms of MPH had a modest effect on the severity of inattention/overactivity and hyperactivity/impulsivity according to parent reports, whereas the short-acting MPH was preferred according to teacher reports for hyperactivity [17]. On the other hand, similar adverse events were observed with IR-and ER-MPH formulations in this study [17].…”