- 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- Unlike previous meta-analyses, this study included unpublished results, making it the most comprehensive look at these medications to date.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.
- 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.
- 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.
- Heterogeneous populations and statistical analyses.
Coauthored with Chitra Ravi, MPharm