Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis
Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis
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DOI：
10.1007/s00787-009-0054-3
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发表时间：
2010-04-01
影响因子：
6.4
通讯作者：
Buitelaar, Jan
中科院分区：
文献类型：
--
作者：
Faraone, Stephen V.;Buitelaar, Jan
用于治疗注意力缺陷/多动障碍（ADHD）的兴奋剂已得到充分研究，但由于缺乏直接比较试验，兴奋剂之间的比较受到阻碍。这项工作的目标是通过双盲安慰剂对照试验的荟萃分析来比较哌醋甲酯和安非他明制剂的功效。我们分析了最近发表的有关多动症兴奋剂治疗的文献，以描述药物-安慰剂效应大小的变异性。我们进行了文献检索，以确定 1979 年之后发表的关于儿童和青少年 ADHD 的双盲、安慰剂对照研究。荟萃分析回归评估了药物类型和研究设计特征对药物效果的影响。二十三项试验符合标准并被纳入本次荟萃分析。这些试验研究了 11 种药物，使用 19 种不同的过度活跃、注意力不集中或冲动行为的结果测量方法。我们发现苯丙胺和哌醋甲酯产品之间存在显着差异，即使在校正了可能混淆结果的研究设计特征后也是如此。我们的分析表明，苯丙胺产品的效应大小显着（尽管中等）大于哌醋甲酯。我们发现所有研究的大多数效果测量都具有统计显着性。我们的研究结果表明，即使在控制了潜在的令人困惑的研究设计特征之后，安非他明产品可能比哌醋甲酯产品更有效。这种效应大小的差异可能是由于苯丙胺和哌甲酯在促进多巴胺能神经传递的分子机制方面存在差异。
Stimulants used to treat attention-deficit/hyperactivity disorder (ADHD) have been well researched, but comparisons among stimulants are hindered by the absence of direct comparative trials. The goal of this work was to compare the efficacy of methylphenidate and amfetamine formulations through a meta-analysis of double-blind placebo-controlled trials. We analyzed recent published literature on the stimulant therapy of ADHD to describe the variability of drug-placebo effect sizes. A literature search was conducted to identify double-blind, placebo-controlled studies of ADHD in children and adolescents published after 1979. Meta-analysis regression assessed the influence of medication type and study design features on medication effects. Twenty-three trials met criteria and were included in this meta-analysis. These trials studied 11 drugs using 19 different outcome measures of hyperactive, inattentive, or impulsive behavior. We found significant differences between amfetamine and methylphenidate products, even after correcting for study design features that might have confounded the results. Our analyses indicate that effect sizes for amfetamine products are significantly, albeit moderately, greater than those for methylphenidate. We found that most measures of effect from all studies were statistically significant. Our findings suggest that amfetamine products may be moderately more efficacious than methylphenidate products, even after controlling for potentially confounding study design features. This difference in effect size may be due to differences between amfetamine and methylphenidate in the molecular mechanisms involved in facilitating the dopaminergic neurotransmission.