![]() ![]() As the largest network meta-analysis to date, it strengthens the evidence behind the NICE guideline. This study supports amphetamines as the first-choice drug treatment for adults with ADHD. This is taken every few hours.Ītomoxetine should be offered to adults if they cannot tolerate lisdexamfetamine or methylphenidate, or their symptoms have not responded to either of these drugs. If it works but has effects that last for too long, standard dexamfetamine can be considered. Lisdexamfetamine is broken down slowly in the body to dexamfetamine and is only taken once per day. It suggests switching to the other of these two drugs if a six-week trial of one hasn’t shown enough benefit. It recommends lisdexamfetamine or methylphenidate as first-line drug treatment for adults. ![]() NICE updated its guidance on the diagnosis and management of ADHD in March 2018. What does current guidance say on this issue? Amphetamines were the only drugs that were more acceptable than placebo, measured as the proportion of participants who left the study for any reason (odds ratio 0.68, 95% CI 0.49 to 0.95).There were no differences between the drugs in terms of tolerability when measured as the proportion of participants who left a study because of side-effects.There was less certainty of a moderate improvement with bupropion (SMD ‑0.46, 95% CI ‑0.85 to ‑0.07), and modafinil was no better than placebo (SMD 0.16, ‑0.28 to 0.59). ![]() Amphetamines greatly improved symptoms (standardised mean difference ‑0.79, 95% confidence interval -0.99 to -0.58).The number of studies for each comparison was not provided in the study report. The majority of trials took place in the US.Ĭore symptoms of ADHD were rated by clinicians, using a variety of scales at 12 weeks.Īll trials were double-blind, so neither the clinician nor the person with ADHD knew which drug they were taking which increases the reliability of the results. The review included unpublished data gathered from study authors, regulatory agencies and drug manufacturers. Due to the small number of trials the amphetamines, (including lisdexamfetamine and dexamfetamine) were grouped together. The network analysis compared a range of drugs used to treat ADHD either with each other or with placebo. Part of this systematic review focused on adults and included 10,296 participants from 52 randomised controlled trials. This review aimed to be more comprehensive, looking at all ages, and the effectiveness and tolerability of a wide range of drugs. Previous network meta-analyses in ADHD have looked just at specific age groups, or a small number of drugs, or safety. Network meta-analyses allow comparisons of drugs, even if they have not been directly tested against each other in trials. It is not clear which drugs are most effective, as they are usually tested against placebos, rather than against each other. methylphenidate and amphetamines) and non-stimulants (e.g. Treatment can involve drugs and psychological interventions such as cognitive behavioural therapy.ĭrug treatments include stimulants (e.g. ADHD affects 3-4% of adults in the UK, who may develop far-reaching, long-lasting negative effects. Why was this study needed?Īttention deficit hyperactivity disorder (ADHD) is a persistent pattern of inattention, hyperactivity and impulsivity that interferes with functioning or learning. ![]() It strengthens the evidence behind NICE guidelines which recommend a trial of either the amphetamine lisdexamfetamine or another stimulant, methylphenidate, as first-line treatments. The network meta-analysis allowed the authors to compare different drugs with each other as well as with placebos (dummy pills). The quality of the included trials was mixed, with only a quarter of the studies having low risk of bias. This large, comprehensive NIHR-funded systematic review included published and unpublished randomised controlled trials of different drug treatments. The review did not identify data to determine whether amphetamines should continue to be used for longer than 12 weeks. Two of these drugs were shown to provide the most improvement in core symptoms of attention deficit hyperactivity disorder, are tolerated as well as any other drug treatment and are less likely to be stopped. There is further evidence to support the amphetamines as the most effective group of drugs for treating adults with attention deficit hyperactivity disorder in the short-term. The views expressed are those of the author(s) and reviewer(s) at the time of publication. This is a plain English summary of an original research article. ![]()
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