Methylphenidate should be considered as a first choice for the treatment of attention-deficit hyperactivity disorder (ADHD) in children and adolescents, while amphetamines should be considered as a first choice in adults, according to a review published online Aug. 7 in The Lancet Psychiatry.
Samuele Cortese, M.D., from the University of Southampton in the United Kingdom, and colleagues conducted a systematic literature review and meta-analysis to compare the efficacy and tolerability of oral medications for ADHD in children, adolescents, and adults. The authors included 133 double-blind randomized controlled trials, both published and unpublished.
The researchers found that for ADHD core symptoms rated by clinicians in children and adolescents closest to 12 weeks, all included drugs were superior to placebo, but for comparisons based on teachers’ ratings, only methylphenidate and modafinil were more efficacious than placebo. For clinicians’ ratings of adult patients, amphetamines, methylphenidate, bupropion, and atomoxetine were better than placebo, but modafinil was not. Amphetamines were inferior in tolerability to placebo in both children and adolescents (odds ratio [OR], 2.3) and adults (OR, 3.26), and guanfacine was inferior to placebo only in children and adolescents (OR, 2.64), while atomoxetine (OR, 2.33), methylphenidate (OR, 2.39) and modafinil (OR, 4.01) were less well tolerated than placebo in adults only. In head-to-head comparisons, differences in efficacy favored amphetamines over modafinil, atomoxetine, and methylphenidate in both children and adolescents and adults.
“Our findings represent the most comprehensive available evidence base to inform patients, families, clinicians, guideline developers, and policymakers on the choice of ADHD medications across age groups,” the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
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