Efficacy of Methylphenidate for Adults with Attention-Deficit Hyperactivity Disorder A Meta-Regression Analysis
Efficacy of Methylphenidate for Adults with Attention-Deficit Hyperactivity Disorder A Meta-Regression Analysis
复制标题
DOI：
10.2165/11539440-000000000-00000
复制
发表时间：
2011-01-01
期刊：
影响因子：
6
通讯作者：
Casas, Miguel
中科院分区：
文献类型：
--
作者：
Castells, Xavier;Antoni Ramos-Quiroga, Josep;Casas, Miguel
背景：哌醋甲酯对患有注意力缺陷多动障碍（ADHD）的成人的疗效显示出广泛的研究间变异性，这在荟萃分析中产生了异质性结果。这种变异的原因尚未得到全面调查。 目的：通过荟萃分析确定哌甲酯治疗相关协变量对成人 ADHD 的影响。还收集了临床和方法学调节因素以及临床试验报告质量，以控制其潜在的混杂效应。方法：我们检索了研究哌甲酯对成人 ADHD 疗效的随机、安慰剂对照临床试验。研究结果是哌甲酯对于减轻多动症症状严重程度的功效。与治疗相关的协变量包括剂量、药物释放制剂的类型（连续药物释放制剂与非连续药物释放制剂）、剂量方案（固定与灵活）和治疗长度。除了临床试验报告质量外，还收集了临床（共病物质使用障碍 [SUD] 的存在）和方法学（设计和评估者）协变量。计算每项研究的标准化平均差（SMD）。通过随机效应荟萃回归分析哌甲酯效应调节剂的影响。结果：纳入了十八项研究。在双变量分析中，剂量、制剂类型和 SUD 似乎改变了哌醋甲酯的功效。这些变量包含在多变量荟萃回归中，结果显示，与安慰剂相比，通过非连续释放制剂给药的平均剂量为 57.4 毫克/天的哌醋甲酯对 ADHD 症状具有中等影响（SMD 0.57-0.58）。发现了剂量-反应关系，表明哌醋甲酯每增加 10 mg，疗效可增加 SMD 0.11-0.12。连续释放制剂和共病 SUD 似乎会降低哌醋甲酯的疗效。然而，治疗制剂的效果可能会受到共病 SUD 的影响，因为所有使用这种持续释放制剂的研究都是在双重 ADHD-SUD 患者中进行的。没有发现残留的异质性。结论：这项研究表明哌醋甲酯以剂量依赖性方式改善成人 ADHD 症状。对于合并 SUD 的患者，哌醋甲酯的疗效似乎会降低。目前尚不清楚哌醋甲酯的疗效是否受制剂类型的影响，因为该协变量的效果与共病 SUD 的效果相混淆。
Background: The efficacy of methylphenidate for adults with attention-deficit hyperactivity disorder (ADHD) shows wide between-study variability, which yields heterogeneous results in meta-analysis. The reasons for this variability have not been comprehensively investigated.Objectives: To determine the influence of treatment-related covariates of methylphenidate for adults with ADHD by means of meta-analysis. Clinical and methodological moderators and clinical trial reporting quality were also collected to control for their potential confounding effect.Methods: We searched for randomized, placebo-controlled clinical trials investigating the efficacy of methylphenidate for adults with ADHD. The study outcome was the efficacy of methylphenidate for reducing ADHD symptom severity. Treatment-related covariates included dose, type of drug-release formulation (formulations with a continuous drug release vs those with a non-continuous drug release), dose regimen (fixed vs flexible) and treatment length. Clinical (presence of co-morbid substance use disorders [SUD]) and methodological (design and rater) covariates were also collected, in addition to clinical trial reporting quality. The standardized mean difference (SMD) was calculated for each study. The analysis of the influence of methylphenidate effect modifiers was performed by means of random-effects meta-regression.Results: Eighteen studies were included. Dose, type of formulation and SUD appeared to modify the efficacy of methylphenidate in the bivariate analysis. These variables were included in a multivariate meta-regression, which showed that methylphenidate, at an average dose of 57.4 mg/day, delivered by means of non-continuous-release formulations, had a moderate effect on ADHD symptoms compared with placebo (SMD 0.57-0.58). A dose-response relationship was found, indicating that efficacy could be increased by SMD 0.11-0.12 for every 10 mg increment of methylphenidate. Continuous-release formulations and co-morbid SUD appeared to reduce the efficacy of methylphenidate. Nevertheless, the effect of treatment formulation may have been confounded by co-morbid SUD, since all studies using this continuous-release formulation were conducted in dual ADHD-SUD patients. No residual heterogeneity was found.Conclusions: This study shows that methylphenidate improves ADHD symptoms in adults in a dose-dependent fashion. The efficacy of methylphenidate appears to be reduced in patients with co-morbid SUD. It is unclear whether methylphenidate efficacy is influenced by the type of formulation, because the effect of this covariate is confounded by that of co-morbid SUD.