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Eur Child Adolesc Psychiatry. 2017 Aug;26(8):875-897. doi: 10.1007/s00787-017-0962-6. Epub 2017 Mar 3.

Comparative efficacy and safety of attention-deficit/hyperactivity disorder pharmacotherapies, including guanfacine extended release: a mixed treatment comparison.

Author information

1
Shire, Zug, Switzerland.
2
Analysis Group, Inc., Economic, Financial, and Strategy Consulting, 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA. Rajeev.Ayyagari@analysisgroup.com.
3
Analysis Group, Inc., Economic, Financial, and Strategy Consulting, 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA.
4
Analysis Group, Inc., New York, NY, USA.
5
University Medicine, Department of Child and Adolescent Psychiatry, Mainz, Germany.
6
Shire, Wayne, PA, USA.

Abstract

This study compared the clinical efficacy and safety of attention-deficit/hyperactivity disorder (ADHD) pharmacotherapy in children and adolescents 6-17 years of age. A systematic literature review was conducted to identify randomized controlled trials (RCTs) of pharmacologic monotherapies among children and adolescents with ADHD. A Bayesian network meta-analysis was conducted to compare change in symptoms using the ADHD Rating Scale Version IV (ADHD-RS-IV), Clinical Global Impression-Improvement (CGI-I) response, all-cause discontinuation, and adverse event-related discontinuation. Thirty-six RCTs were included in the analysis. The mean (95% credible interval [CrI]) ADHD-RS-IV total score change from baseline (active minus placebo) was -14.98 (-17.14, -12.80) for lisdexamfetamine dimesylate (LDX), -9.33 (-11.63, -7.04) for methylphenidate (MPH) extended release, -8.68 (-10.63, -6.72) for guanfacine extended release (GXR), and -6.88 (-8.22, -5.49) for atomoxetine (ATX); data were unavailable for MPH immediate release. The relative risk (95% CrI) for CGI-I response (active versus placebo) was 2.56 (2.21, 2.91) for LDX, 2.13 (1.70, 2.54) for MPH extended release, 1.94 (1.59, 2.29) for GXR, 1.77 (1.31, 2.26) for ATX, and 1.62 (1.05, 2.17) for MPH immediate release. Among non-stimulant pharmacotherapies, GXR was more effective than ATX when comparing ADHD-RS-IV total score change (with a posterior probability of 93.91%) and CGI-I response (posterior probability 76.13%). This study found that LDX had greater efficacy than GXR, ATX, and MPH in the treatment of children and adolescents with ADHD. GXR had a high posterior probability of being more efficacious than ATX, although their CrIs overlapped.

KEYWORDS:

Adolescents; Attention-deficit/hyperactivity disorder; Children; Efficacy; Meta-analysis; Mixed treatment comparison

PMID:
28258319
PMCID:
PMC5532417
DOI:
10.1007/s00787-017-0962-6
[Indexed for MEDLINE]
Free PMC Article

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