Efficacy, safety and variability in pharmacotherapy for adults with attention deficit hyperactivity disorder: a meta-analysis and meta-regression in over 9000 patients

Rationale The factors underlying the variability in the results of randomized, placebo-controlled clinical trials (RPCCT) assessing pharmacological interventions for adults with attention deficit hyperactivity disorder (ADHD) are not fully understood. Methods A systematic review and meta-analysis of...

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Bibliographic Details
Published in:Psychopharmacology 2016, Vol.233 (2), p.187-197
Main Authors: Cunill, R., Castells, X., Tobias, A., Capellà, D.
Format: Article
Language:English
Subjects:
Adult
Adults
Attention Deficit Disorder with Hyperactivity - complications
Attention Deficit Disorder with Hyperactivity - drug therapy
Attention Deficit Disorder with Hyperactivity - psychology
Attention deficit hyperactivity disorder
Biomedical and Life Sciences
Biomedicine
Care and treatment
Central Nervous System Stimulants - adverse effects
Central Nervous System Stimulants - therapeutic use
Clinical Trials as Topic
Drug therapy
Health aspects
Humans
Meta-analysis
Neurosciences
Original Investigation
Patient Safety
Pharmacology/Toxicology
Psychiatry
Psychopharmacology
Psychotropic drugs
Systematic review
Treatment Outcome
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Summary:Rationale The factors underlying the variability in the results of randomized, placebo-controlled clinical trials (RPCCT) assessing pharmacological interventions for adults with attention deficit hyperactivity disorder (ADHD) are not fully understood. Methods A systematic review and meta-analysis of RPCCT comparing pharmacological treatment and placebo in adults with ADHD was carried out. The study outcomes were all-cause treatment discontinuation, efficacy on ADHD symptoms, and safety. Patient-, intervention-, and study design-related covariates were collected. Meta-regression methods were applied. Results Forty-four studies involving 9952 patients were included. All-cause treatment discontinuation was slightly higher with pharmacological treatment than with placebo (odds ratio (OR) = 1.18; 95 % confidence interval (CI) 1.02, 1.36; p  = 0.003). A better outcome on all-cause treatment discontinuation was observed in studies that provided concomitant psychotherapy when compared to those that did not (rate of OR (ROR) = 0.68, p  = 0.048). Pharmacological treatment was efficacious for reducing ADHD symptoms (standardized mean difference (SMD) = 0.45; 95 % CI 0.37, 0.52; p  
ISSN:0033-3158
1432-2072
DOI:10.1007/s00213-015-4099-3