PMID- 26446868
OWN - NLM
STAT- MEDLINE
DCOM- 20160808
LR  - 20181202
IS  - 1432-2072 (Electronic)
IS  - 0033-3158 (Linking)
VI  - 233
IP  - 2
DP  - 2016 Jan
TI  - Efficacy, safety and variability in pharmacotherapy for adults with attention 
      deficit hyperactivity disorder: a meta-analysis and meta-regression in over 9000 
      patients.
PG  - 187-97
LID - 10.1007/s00213-015-4099-3 [doi]
AB  - 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 < 0.00001), with stronger intervention 
      effects found in studies investigating stimulant drugs (difference of SMD (Diff 
      SMD) = 0.18, p = 0.017), in shorter studies (Diff SMD = -0.01, p = 0.044), and 
      when clinician-rated scales were used (Diff SMD = 0.44, p < 0.0001). 
      Pharmacological treatment was associated with more frequent adverse events (AEs) 
      (OR = 2.29; 95 % CI 1.97, 2.66; p = 0.006). Studies with a lead-in phase and with 
      a higher proportion of patients previously treated with stimulants were 
      associated with a better safety outcome (ROR = 0.59, p = 0.017; ROR = 0.98, 
      p = 0.036, respectively). CONCLUSION: Pharmacological treatment provides mild 
      symptom improvement but is associated with frequent AEs and higher treatment 
      discontinuation than placebo, particularly when no concomitant psychotherapy is 
      administered. Stimulants appear more efficacious than non-stimulant drugs and the 
      former should be preferred over the latter. The efficacy of pharmacological 
      treatment should be monitored over time because it may decrease progressively.
FAU - Cunill, R
AU  - Cunill R
AD  - Parc Sanitari Sant Joan de Deu, Fundacio Sant Joan de Deu, Barcelona, Spain.
FAU - Castells, X
AU  - Castells X
AD  - Clinical Pharmacology Unit, TransLab Research Group, Department of Medical 
      Sciences, Universitat de Girona, Emili Grahit, 77, 17071, Girona, Spain. 
      xavier.castells@udg.edu.
FAU - Tobias, A
AU  - Tobias A
AD  - Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council 
      for Scientific Research (CSIC), Barcelona, Spain.
FAU - Capella, D
AU  - Capella D
AD  - Clinical Pharmacology Unit, TransLab Research Group, Department of Medical 
      Sciences, Universitat de Girona, Emili Grahit, 77, 17071, Girona, Spain.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20151008
PL  - Germany
TA  - Psychopharmacology (Berl)
JT  - Psychopharmacology
JID - 7608025
RN  - 0 (Central Nervous System Stimulants)
SB  - IM
MH  - Adult
MH  - Attention Deficit Disorder with Hyperactivity/complications/*drug 
      therapy/psychology
MH  - Central Nervous System Stimulants/*adverse effects/*therapeutic use
MH  - Clinical Trials as Topic
MH  - Humans
MH  - Patient Safety
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Attention deficit hyperactivity disorder
OT  - Efficacy
OT  - Meta-analysis
OT  - Meta-regression
OT  - Placebo-controlled clinical trial
OT  - Safety
OT  - Systematic review
EDAT- 2015/10/09 06:00
MHDA- 2016/08/09 06:00
CRDT- 2015/10/09 06:00
PHST- 2015/07/16 00:00 [received]
PHST- 2015/09/19 00:00 [accepted]
PHST- 2015/10/09 06:00 [entrez]
PHST- 2015/10/09 06:00 [pubmed]
PHST- 2016/08/09 06:00 [medline]
AID - 10.1007/s00213-015-4099-3 [pii]
AID - 10.1007/s00213-015-4099-3 [doi]
PST - ppublish
SO  - Psychopharmacology (Berl). 2016 Jan;233(2):187-97. doi: 
      10.1007/s00213-015-4099-3. Epub 2015 Oct 8.