Medical Journal of the Islamic Republic Of Iran
مجله پزشکی جمهوری اسلامی ایران
Med J Islam Repub Iran
Medical Sciences
http://mjiri.iums.ac.ir
2
journal2
1016-1430
2251-6840
8
10.18869/mjiri
14
8888
13
en
jalali
1394
10
1
gregorian
2016
1
1
30
1
online
1
fulltext
en
Comparative efficacy of methylphenidate and atomoxetine in the treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review and meta-analysis
Health Technology Assessment
Health Technology Assessment
Original Research
Original Research
<p dir="ltr" style="text-align: justify;"><strong>Background: </strong>The aim of this study was to directly compare efficacy of atomoxetine and methylphenidate in treatment of children and adolescents 6- 18 years.</p>
<p dir="ltr" style="text-align: justify;"><strong> Methods</strong>: All published, randomized, open label or double blind trials, comparing the efficacy of methylphenidate with atomoxetine in treatment of children diagnosed with ADHD, using DSM-IV criteria were included in this study; ADHD Rating Scale–IV–Parent Version: Investigator Administered and Scored (ADHDRS) scores was used. The standardized mean difference (SMD) was used as a measure of effect size.</p>
<p dir="ltr" style="text-align: justify;"><strong> Results</strong>: Eleven studies were included with a total of 2,772 participants. The meta-analysis did not find a significant difference in the efficacy between methylphenidate and atomoxetine (SMD= 0.09, 95% CI -0.06, 0.25) (Z= 1.18, p= 0.24). Sub group analysis showed a significant standardized mean difference favoring OROS methylphenidate (SMD= 0.31, 95% CI 0.16, 0.47 (Z= 3.91, p< 0.0001); immediate release methylphenidate was not superior to atomoxetine (SMD= -0.05, 95% CI -0.20, 0.10) (Z= 0.68, p= 0.49). Open label trials did not make a difference in the standardized mean difference (SMD= 0.10, 95% CI -0.02, 0.23) (Z= 1.17, p= 0.09). There was significant heterogeneity among the studies (p= 0.003, I2= 63%). Subgroup analysis demonstrated that heterogeneity was because of the open label trials (p= 0.009, I2= 79%).</p>
<p dir="ltr" style="text-align: justify;"><strong> Conclusion</strong>: Atomoxetine and methylphenidate showed comparable efficacy in the treatment of children and adolescents with ADHD. However, Osmotic (Controlled) Release Oral (Delivery) System (OROS) methylphenidate is more effective than atomoxetine in treatment of ADHD in children and adolescents that is suggested as a first-line treatment in ADHD. Moreover, comparing the immediate release (IR) methylphenidate to atomoxetine did not lead to the benefit of IR methylphenidate.</p>
Atomoxetine, ADHD, Child, Adolescents, Meta-analysis, Methylphenidate.
110
121
http://mjiri.iums.ac.ir/browse.php?a_code=A-10-1-962&slc_lang=en&sid=1
Golandam
Rezaei
g.rezaei.hta@gmail.com
200319475328460021396
200319475328460021396
No
Health Technology Assessment of Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Seyed Alireza
Hosseini
a.hosseini@fda.gov.ir
200319475328460021397
200319475328460021397
Yes
Food & Drug Research Center, Clinical Trials group, Food and Drug Administration, Tehran, Iran.
Ali
Akbari Sari
. akbarisari@sina.tums.ac.ir
200319475328460021398
200319475328460021398
No
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Alireza
Olyaeemanesh
arolyaee@gmail.com
200319475328460021399
200319475328460021399
No
National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran.
Mohamad Hassan
Lotfi
mhlotfi56359@gmail.com
200319475328460021400
200319475328460021400
No
Biostatistics & Epidemiology Department, Public Health Faculty, Shaheed Sadoughi University of Medical Sciences, Yazd, Iran.
Mojtaba
Yassini
yassiniard@yahoo.com
200319475328460021401
200319475328460021401
No
Psychiatry Department of Psychiatry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Reza
Bidaki
Reza_Bidaki@yahoo.com
200319475328460021402
200319475328460021402
No
Department of Psychiatry, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
Bijan
Nouri
bijannuri@gmail.com
200319475328460021403
200319475328460021403
No
Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.