Comparative efficacy, acceptability, and tolerability of dexmethylphenidate versus placebo in child and adolescent ADHD: a meta-analysis of randomized controlled trials

Abstract

BackgroundThe efficacy of dexmethylphenidate (d-MPH) has been proven in the treatment of children and adolescents with attention-deficit hyperactivity disorder (ADHD).ObjectiveThe aim of this systematic review is to determine the efficacy, acceptability, and tolerability of d-MPH in child and adolescent ADHD.MethodsThe searches of SCOPUS, MEDLINE, CINAHL, and Cochrane Controlled Trials Register were performed in February 2015. All randomized controlled trials of d-MPH versus placebo that were performed in children and adolescents with ADHD up to 18 years of age were included in the study. The efficacy was measured by using the pooled mean-endpoint or mean-changed scores of ADHD rating scales and the response rate. Acceptability and tolerability were measured by using the pooled rates of overall discontinuation and discontinuation due to adverse events, respectively.ResultsA total of 1,124 children and adolescents diagnosed as having ADHD were included in this review. In a laboratory school setting, the pooled mean-change and mean-endpoint scores in the d-MPH-treated group were significantly greater than those of the placebo-treated group with standardized mean difference (95% confidence interval [CI]) of −1.20 (−1.73, −0.67), I2=95%. Additionally, the pooled mean-changed scores of the ADHD rating scales for teachers and parents in the d-MPH-treated group were significantly greater than that of the placebo-treated group with weighted mean difference (95% CI) of −13.01 (−15.97, −10.05), I2=0% and (95% CI) of −12.99 (−15.57, −10.42), I2=0%, respectively. The pooled response rate in the d-MPH-treated groups had a significance higher than that of the placebo-treated group. The rates of pooled overall discontinuation and discontinuation due to adverse events between the two groups were not significantly different.ConclusionBased on the findings in this review, it can be concluded that d-MPH medication is efficacious and tolerable in child and adolescent ADHD. However, the acceptability of d-MPH is no greater than that of the placebo. Further systematic studies may confirm these findings.

The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder

“…There was no evidence of serious adverse events, and just a slightly elevated risk of non-serious side effects (Storebø et al, 2015). 152 A meta-analysis found dexmethylphenidate strongly reduced youth ADHD symptoms relative to placebo (seven studies, almost 1500 participants), and had three times the clinical response rate (four studies, over 600 participants) (Maneeton et al, 2015).…”

Integrated use of biofeedback and neurofeedback techniques in treating pathological conditions and improving performance: a narrative review

“…In addition оn the methodological critique оf neurofeedback (NF), іt іs imperative tо consider the analogy between sham controls іn NF research and placebo controls іn medication studies. Recent discussions, as highlighted by studies such as those by Maneeton et al (2015) have emphasized the substantial effects оf placebos іn medication trials. This іs particularly relevant when comparing the efficacy оf medications like methylphenidate (MPH) against placebo, where the difference, albeit significant, also underscores the non-negligible impact оf placebo itself.…”

Funções Executivas, Atenção e o Uso do Metilfenidato: Estudo de Revisão Sistemática

“…Itaborahy e Ortega (2013) pontuam benefícios como a melhoria na qualidade do sono, baixa toxidade, segurança clínica e superioridade, quando comparado com o placebo ou com a psicoterapia. Ortega et al (2010) Bezerra (2014), Bolfer (2014), Brant e Carvalho (2012), Ferreira (2006, Maneeton et al (2015) e Murray et al (2011), asseveram que, além de diminuir os sintomas do transtorno, melhora as habilidades atencionais e as habilidades de funções executivas. Porém, de acordo com Andrade e Scheuer (2004), há autores estrangeiros cujos estudos revelaram que, em média, um quarto das crianças com TDAH não apresentam melhora ao usarem MPH ou que 20,4% delas não são beneficiadas e podem até piorar.…”