Author/Authors :
Rezaei, Golandam Health Technology Assessment of Shahid Sadoughi University of Medical Sciences, Yazd, Iran , Hosseini, Alireza Food & Drug Research Center - Clinical Trials group - Food and Drug Administration, Tehran, Iran , Akbari Sari, Ali Department of Health Management and Economics - School of Public Health, Tehran University of Medical Sciences, Tehran, Iran , Olyaeemanesh, Alireza National Institute for Health Research - Tehran University of Medical Sciences, Tehran, Iran , Lotfi, Mohamad Hassan Biostatistics & Epidemiology Department - Public Health Faculty - Shaheed Sadoughi University of Medical Sciences, Yazd, Iran , Yassini, Mojtaba Psychiatry Department of Psychiatry - Shahid Sadoughi University of Medical Sciences, Yazd, Iran , Bidaki, Reza Department of Psychiatry - Rafsanjan University of Medical Sciences, Rafsanjan, Iran , Nouri, Bijan Social Determinants of Health Research Center - Kurdistan University of Medical Sciences Sanandaj, Iran
Abstract :
Background: The aim of this study was to directly compare efficacy of atomoxetine and
methylphenidate in treatment of children and adolescents 6- 18 years.
Methods: 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.
Results: 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%).
Conclusion: 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.
Keywords :
Methylphenidate , Meta-analysis , Adolescents , Child , ADHD , Atomoxetine
