Optimal ADHD medication differs between adult and pediatric populations

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Takeaway

  • The optimal ADHD medication choice differs between the pediatric and adult populations.
  • Methylphenidate (e.g., Concerta) has the best safety/efficacy profile in children and adolescents, whereas amphetamines look best in adults.

Why this matters

  • Unlike previous meta-analyses, this study included unpublished results, making it the most comprehensive look at these medications to date.
  • According to an accompanying editorial, the current study clarifies inconsistencies from previous reviews, which had generated controversy.

Study design

  • Network meta-analysis of 133 studies (efficacy: 10,068 children/adolescents, 8131 adults; tolerability: 11,018 children/adolescents, 5362 adults).
  • Funding: Stichting Eunethydis; UK National Institute for Health Research.

Key results

  • Clinician rating for ADHD core symptoms for methylphenidate for children/adolescents vs amphetamine for adults:
    • Standardized mean difference (SMD), −0.78 (95% CI, −0.93 to −0.62) vs −0.79 (95% CI, −0.99 to −0.58), respectively.
    • Acceptability (significantly better than placebo): OR, 0.69 (95% CI, 0.52-0.91) vs OR, 0.68 (95% CI, 0.49-0.95).  
  • Tolerability was inferior to placebo (children and adolescents vs adults):
    • Amphetamines: OR, 2.30 (95% CI, 1.36-3.89) vs OR, 3.26 (95% CI, 1.54-6.92); and
    • Methylphenidate: OR, 1.44 (95% CI, 0.90-2.31) vs OR, 2.39 (95% CI, 1.40-4.08).
  • Except for modafinil (e.g., Provigil), all included drugs had better efficacy than placebo.

Limitations

  •  Heterogeneous populations and statistical analyses.

Coauthored with Chitra Ravi, MPharm