PMID- 24472252
OWN - NLM
STAT- MEDLINE
DCOM- 20150326
LR  - 20220310
IS  - 1527-5418 (Electronic)
IS  - 0890-8567 (Linking)
VI  - 53
IP  - 2
DP  - 2014 Feb
TI  - Efficacy and safety of atomoxetine in children and adolescents with 
      attention-deficit/hyperactivity disorder: results from a comprehensive 
      meta-analysis and metaregression.
PG  - 174-87
LID - S0890-8567(13)00814-9 [pii]
LID - 10.1016/j.jaac.2013.11.005 [doi]
AB  - OBJECTIVE: To comprehensively evaluate the efficacy and safety of atomoxetine 
      (ATX) in pediatric attention-deficit/hyperactivity disorder (ADHD). METHOD: 
      Meta-analysis of all double-blind randomized controlled trials (DBRCTs) 
      evaluating the efficacy and tolerability of ATX for ADHD. Pooled, random-effects 
      analyses were conducted, calculating standardized mean difference (SMD), yielding 
      effect sizes (ES), relative risk (RR), and number-needed-to-treat/harm 
      (NNT/NNH).Moderator/mediator analyses were also conducted, including 
      metaregression. RESULTS: Across 25 DBRCTs (56 treatment arms, N = 3,928), ATX 
      outperformed placebo regarding overall ADHD symptoms (ES = -0.64, 95% confidence 
      interval [CI] = -0.56 to -0.71, p < 0.0001), hyperactivity/impulsivity (ES = 
      -0.67, CI = -0.53 to -0.81, p < 0.0001), and inattention (ES = -0.59, CI = -0.51 
      to -0.67, p < 0.0001). Altogether, 44.4% versus 21.4% of patients improved by 
      >/=40% (NNT = 4), whereas 39.9% versus 65.9% improved by <25% (NNT = 4). 
      Oppositional defiant disorder symptoms (ES = -0.33) and quality-of-life-related 
      outcomes (ES = -0.48 to -0.25) improved somewhat less. A higher percentage of 
      treatment-naive patients moderated the efficacy of ATX for overall ADHD symptoms 
      (p = 0.017). All-cause discontinuation with ATX was similar to that for placebo 
      (p = 1.00), with lower discontinuation because of inefficacy (relative risk [RR] 
      = 0.51, CI = 0.36-0.74, p < 0.0001, NNT = 34), but higher discontinuation because 
      of adverse effects (AEs) (RR = 1.89, CI = 1.08-3.31, p = 0.03, NNH = 50) with 
      ATX. At least 1 adverse effect (AE) (70.4% versus 56.1%, p < 0.01, NNH = 6) and 
      >/=1 psychiatric AE (21.5% versus 7.4%, NNH = 7, p < 0.01) were more frequent with 
      ATX, whereas serious AEs (1.5% versus 1.0%), aggression (7.5% versus 6.0%), and 
      suicidal ideation (1.3% versus 0.9%) were not different from placebo. 
      CONCLUSIONS: Short-term ATX treatment is safe and superior to placebo for overall 
      ADHD symptoms and key secondary outcomes, with a medium ES. However, a relevant 
      patient subgroup (40%) continues to have significant symptomatology, requiring 
      additional clinical attention.
CI  - Copyright (c) 2014 American Academy of Child and Adolescent Psychiatry. Published 
      by Elsevier Inc. All rights reserved.
FAU - Schwartz, Shimon
AU  - Schwartz S
AD  - Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish 
      (LIJ) Health System, and Montefiore Medical Center.
FAU - Correll, Christoph U
AU  - Correll CU
AD  - Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish 
      Health System, Hofstra North Shore-LIJ School of Medicine, Albert Einstein 
      College of Medicine, and the Feinstein Institute for Medical Research. Electronic 
      address: ccorrell@lij.edu.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20131126
PL  - United States
TA  - J Am Acad Child Adolesc Psychiatry
JT  - Journal of the American Academy of Child and Adolescent Psychiatry
JID - 8704565
RN  - 0 (Adrenergic Uptake Inhibitors)
RN  - 0 (Propylamines)
RN  - 57WVB6I2W0 (Atomoxetine Hydrochloride)
SB  - IM
CIN - J Am Acad Child Adolesc Psychiatry. 2014 Feb;53(2):135-7. PMID: 24472248
CIN - Evid Based Ment Health. 2014 Nov;17(4):108. PMID: 25165169
MH  - Adolescent
MH  - Adrenergic Uptake Inhibitors/administration & dosage/adverse 
      effects/*pharmacology
MH  - Atomoxetine Hydrochloride
MH  - Attention Deficit Disorder with Hyperactivity/*drug therapy
MH  - Child
MH  - Humans
MH  - Propylamines/administration & dosage/adverse effects/*pharmacology
MH  - *Treatment Outcome
OTO - NOTNLM
OT  - atomoxetine
OT  - attention-deficit/hyperactivity disorder (ADHD)
OT  - children
OT  - efficacy
OT  - safety
EDAT- 2014/01/30 06:00
MHDA- 2015/03/27 06:00
CRDT- 2014/01/30 06:00
PHST- 2013/05/15 00:00 [received]
PHST- 2013/09/17 00:00 [revised]
PHST- 2013/11/21 00:00 [accepted]
PHST- 2014/01/30 06:00 [entrez]
PHST- 2014/01/30 06:00 [pubmed]
PHST- 2015/03/27 06:00 [medline]
AID - S0890-8567(13)00814-9 [pii]
AID - 10.1016/j.jaac.2013.11.005 [doi]
PST - ppublish
SO  - J Am Acad Child Adolesc Psychiatry. 2014 Feb;53(2):174-87. doi: 
      10.1016/j.jaac.2013.11.005. Epub 2013 Nov 26.