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29 Feb 2016

Cunill R et al. Psychopharmacology 2016; 233: 178-197.

Pharmacotherapy in adults with ADHD is associated with symptom improvement and increased incidence of adverse events compared with placebo, results of a recent large meta-analysis suggest.

In this study, a meta-regression analysis was used to investigate the efficacy, safety and all-cause treatment discontinuation of pharmacological interventions for adults with ADHD, taking into account covariates relating to patient, intervention and study design. A total of 44 randomised, placebo-controlled clinical trials involving 9952 patients were identified for inclusion based on systematic review of the literature.

Results indicated that pharmacological treatment was associated with higher rates of all-cause treatment discontinuation compared with placebo (31 vs 29%; odds ratio [OR] 1.18, 95% confidence interval [CI] 1.02, 1.36; p=0.003), although this was reduced with concomitant psychotherapy compared with placebo (OR 0.91; 95% CI 0.61, 1.35; p=0.64). More adverse events were observed with pharmacotherapy than with placebo (78 vs 63%; OR 2.29; 95% CI 1.97, 2.66; p=0.006).

Pharmacological treatment was more efficacious than placebo in reducing ADHD symptom severity (standardised mean difference 0.45; 95% CI 0.37 to 0.52; p<0.00001); and the observed effects were greater in studies with stimulant drugs (p=0.017), shorter duration of treatment (p=0.044) when clinician-rated scales were used (p<0.0001). Gender, age, comorbidity and ADHD severity did not significantly affect pharmacological treatment outcomes.

Overall, compared with placebo, pharmacological treatment was more efficacious in reducing ADHD symptom severity in adults with ADHD, although it was associated with more adverse events and treatment discontinuation. The researchers noted that comparisons were indirect and no adjustment was made for multiple comparisons, therefore results should be interpreted with caution and confirmed by further research.

Read more about pharmacotherapy in adults with ADHD here

Cunill R, Castells X, Tobias A, et al. Efficacy, safety and variability in pharmacotherapy for adults with attention deficit hyperactivity disorder: a meta-analysis and meta-regression in over 9000 patients. Psychopharmacology 2016; 233: 178-197.

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