European Journal of Clinical Pharmacology

, Volume 69, Issue 3, pp 347–356

Treatment discontinuation with methylphenidate in adults with attention deficit hyperactivity disorder: a meta-analysis of randomized clinical trials

CLINICAL TRIAL

DOI: 10.1007/s00228-012-1390-7

Cite this article as:
Castells, X., Cunill, R. & Capellà, D. Eur J Clin Pharmacol (2013) 69: 347. doi:10.1007/s00228-012-1390-7

Abstract

Background

Attention deficit hyperactivity disorder (ADHD) in adulthood is increasingly diagnosed and treated. Methylphenidate is frequently advocated as a first-line pharmacological treatment.

Purpose

The aim of our study was to compare all-cause discontinuation rate of methylphenidate and its pharmaceutical presentations with placebo in adults with ADHD.

Methods

This was a systematic review and meta-analysis of randomized controlled trials comparing methylphenidate with placebo in adults with ADHD. All-cause treatment discontinuation was the primary endpoint. The efficacy in reducing ADHD symptoms and safety were the secondary endpoints.

Results

Twelve studies (2,496 patients) met the inclusion criteria. Four racemic methylphenidate and one dexmethylphenidate presentations were investigated. The rate of all-cause treatment discontinuation was greater with methylphenidate than with placebo, but this difference was not statistically significant [odds ratio (OR) 1.19, 95 % confidence interval (95 % CI) 0.82–1.74, P = 0.37, I2 = 64 %] This finding reached the conventional threshold of statistical significance after one outlier study was excluded (OR 1.44, 95 % CI 1.14–1.82, P = 0.002, I2 = 0). Methylphenidate was more efficacious than placebo for reducing ADHD symptoms and it was associated with a higher proportion of patients dropping out due to adverse effects.

Conclusions

Despite reducing ADHD symptoms, methylphenidate showed no advantage over placebo in terms of treatment discontinuation. More attention should be given in the future to the endpoint “all-cause treatment discontinuation” when making regulatory decisions and developing clinical guidelines involving the treatment of ADHD in adulthood.

Keywords

Attention deficit hyperactivity disorder Adulthood Methylphenidate All-cause treatment discontinuation Meta-analysis 

Supplementary material

228_2012_1390_MOESM1_ESM.doc (60 kb)
ESM 1(DOC 60 kb)
228_2012_1390_MOESM2_ESM.doc (80 kb)
ESM 2(DOC 79 kb)
228_2012_1390_MOESM3_ESM.doc (58 kb)
ESM 3(DOC 58 kb)
228_2012_1390_MOESM4_ESM.doc (63 kb)
ESM 4(DOC 63 kb)
228_2012_1390_MOESM5_ESM.doc (61 kb)
ESM 5(DOC 61 kb)
228_2012_1390_MOESM6_ESM.doc (64 kb)
ESM 6(DOC 64 kb)
228_2012_1390_MOESM7_ESM.doc (80 kb)
ESM 7(DOC 80 kb)
228_2012_1390_MOESM8_ESM.doc (60 kb)
ESM 8(DOC 60 kb)

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Medical SciencesTransLab research group, Universitat de GironaGironaSpain
  2. 2.Parc Sanitari Sant Joan de DéuUnitat d’Hospitalització Psiquiàtrica PenitenciàriaBarcelonaSpain