Pharmacotherapy of adult attention deficit hyperactivity disorder (ADHD): a meta-analysis

Abstract

Our objective was to conduct a meta-analysis of therapeutic efficacy of pharmacological treatment of adult ADHD based on data from controlled clinical trials. We used the search engines PubMed and Medline to identify relevant clinical trials. Short-term studies with double-blind parallel-group design were selected for the analysis. Altogether, we identified 11 trials that met the criteria, and investigated a total of 1991 subjects, 694 and 1297 of whom were treated with placebo or active medication, respectively. In order to pool efficacy data from studies with different characteristics, including different number of participants, different trial duration and measures of efficacy, the statistical effect sizes for each study had to be calculated. Our findings showed that the pooled effect size across all treatments was in the medium-to-high range (Cohen's d=0.65, p<0.0001 vs. placebo), and the effect size for stimulants (Cohen's d=0.67, p<0.0001 vs. placebo) was somewhat higher than for non-stimulant medications (Cohen's d=0.59, p<0.0001 vs. placebo). The current database of controlled trials for adult ADHD is relatively small, and does not include data for many of the potentially important agents. In addition, effect-size estimates for different classes of medications (i.e. stimulant and non-stimulant medications) were based on separate studies; head-to-head comparisons of various agents are severely lacking. Nonetheless, results of this meta-analysis across all ADHD medications in adult subjects demonstrated statistically significant and clinically robust improvement in symptom severity compared to placebo treatment.

Developments and challenges in the diagnosis and treatment of ADHD

“…97 Non-stimulants, when considered as a group, seem to be inferior to stimulants, with pooled effect size of 0.39 53 and 0.59. 95 Meta-analytic data also showed bupropion to be superior to placebo but less effective than stimulants. 58,98,99 Other non-stimulants were assessed by clinical trials with no meta-analysis yet available.…”

“…When stimulants as a group are compared to placebo, the effect size found is 0.67. 95 Other meta-analyses found effect sizes of 0.9 for methylphenidate, 96 0.73 for mixed amphetamine salts, 97 0.8 for lisdexamfetamine (extracted from a single study), 97 and 0.6 for dextroamphetamine. 97 Non-stimulants, when considered as a group, seem to be inferior to stimulants, with pooled effect size of 0.39 53 and 0.59.…”

Attention-deficit/hyperactivity disorder in persistent criminal offenders: the need for specialist treatment programs

“…The NICE guidelines recommended treatment with medication as the first-line treatment for adults with ADHD [20], and drug treatment has been shown to be effective in reducing ADHD symptoms in adulthood [21]. Treatment of ADHD may lead to improvements in comorbid disorders, such as antisocial and border line personality disorders, substance abuse disorders, anxiety and depression.…”

Transtorno de déficit de atenção/hiperatividade e epilepsia: eficácia e segurança do metilfenidato em crianças e adolescentes com crises epilépticas não controladas

“…O metilfenidato (MTF) é a primeira opção na terapêutica medicamentosa do TDAH o que se demonstra avaliando-se o tamanho de efeito das diversas possibilidades medicamentosas, parâmetro mais adequado para comparar a eficácia entre medicações quando não há estudos bastante esclarecedores que avaliem diretamente a eficácia de uma medicação em relação à outra [17][18][19][20][21] .…”

“…Corresponde à diferença entre um grupo de pacientes que recebeu a medicação e outro que recebeu placebo, dividido pelo desviopadrão combinado desses grupos. O tamanho de efeito igual ou maior que 0,6 é considerado grande; é definido como médio, quando entre 0,3 e 0,5 e pequeno, se menor que 0,3 [17][18][19][20] . A prevalência varia de 2,2% até 17,8% e é provável que essa variação decorra mais das escolhas metodológicas dos diversos estudos do que das diferenças geográficas [29][30][31] .…”