Comparative benefits and harms of competing medications for adults with attention-deficit hyperactivity disorder: a systematic review and indirect comparison meta-analysis
Abstract
Rationale Recommended medication prescribing hierarchies for adult attention-deficit hyperactivity disorder (ADHD) vary between different guideline committees. Few trials directly compare competing ADHD medications in adults and provide little insight for clinicians making treatment choices. Objective The objective of this study was to assess comparative benefits and harms of competing medications for adult ADHD using indirect comparison meta-analysis. Materials and methods Eligible studies were English-language publications of randomized controlled trials comparing ADHD drugs to placebo. Data sources were electronic bibliographic databases, Drugs@FDA, manufacturer data, and reference lists. Two reviewers independently abstracted data on design, internal validity, population, and results. Benefits and harms were compared between drug types using indirect comparison meta-regression (ratio of relative risks). Results Twenty-two placebo-controlled trials were included (n = 2,203). Relative benefit of clinical response for shorter-acting stimulants, primarily immediate release methylphenidate, was 3.26 times greater than for patients taking longer-acting stimulants (95% CI 2.03, 5.22) and 2.24 times greater than for patients taking longer-acting forms of bupropion (95% CI 1.23, 4.08). Immediate release methylphenidate is also the only drug shown to reduce ADHD symptoms in adults with substance abuse disorders. Neither non-stimulants nor longer-acting stimulants reduced adverse ef…
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Previous network meta-analyses in ADHD have focused on either children and adolescents or adults only, have typically compared only a few drugs, or have addressed exclusively the safety of treatments.
“Previous network meta-analyses in ADHD have focused on either children and adolescents19, 20, 21, 22, 23, 24 or adults only,25, 26, 27, 28 have typically compared only a few drugs,24, 25, 27, 29 or have addressed exclusively the safety of treatments.26”
Immediate-release methylphenidate is superior to other ADHD treatments in terms of benefits and harms, according to a systematic review and meta-analysis.
“One systematic review and meta-analysis of treatments for ADHD concluded that immediate-release methylphenidate was superior to other treatments in terms of benefits and harms [110].”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [110]
Short-acting stimulants have similar risk profiles to atomoxetine, long-acting bupropion, and extended-release stimulants, but greater efficacy in symptom reduction.
“It also supported the efficacy of atomoxetine, long-acting bupropion, and extendedrelease stimulants, but found that short-acting stimulants had similar risk-profiles to these other options, with greater efficacy in terms of symptom reduction.”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [110]
Atomoxetine, long-acting bupropion, and extended-release stimulants are efficacious for ADHD.
“It also supported the efficacy of atomoxetine, long-acting bupropion, and extendedrelease stimulants, but found that short-acting stimulants had similar risk-profiles to these other options, with greater efficacy in terms of symptom reduction.”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [110]
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References 43 · Cited by 135
- Authors
- Peterson, K., McDonagh, M. S., & Fu, R.
- Affiliations
- Oregon Health & Science University (US)
- Corresponding author
- Peterson, Kim
- Venue
- Psychopharmacology
- Published
- 2007-11-17
- Volume
- 197
- Issue
- 1
- Pages
- 1-11
- ISSN
- 0033-3158 (ISSN-L)
- 1432-2072
- OpenAlex
- W2085046856
- Cited by
- 135
- References
- 43
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 8 · 2023: 7 · 2022: 3 · 2021: 4 · 2020: 1 · 2019: 4 · 2018: 5 · 2017: 10 · 2016: 6 · 2015: 8 · 2014: 14 · 2013: 8 · 2012: 14
- FWCI
- 1.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neuroethics, Human Enhancement, Biomedical Innovations
- Keywords
- adult ADHD, ADHD medication, immediate-release methylphenidate, long-acting stimulants, bupropion, non-stimulant medication, stimulant side effects, substance use comorbidity, first-line therapy, prescribing guidelines, indirect comparison
- MeSH terms
- Atomoxetine Hydrochloride, Adult, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Delayed-Action Preparations, Humans, Propylamines, Psychotropic Drugs, Bupropion, Treatment Outcome, Adverse Drug Reaction Reporting Systems, Adrenergic Uptake Inhibitors, Dopamine Uptake Inhibitors, Controlled Clinical Trials as Topic
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