Atomoxetine treatment for children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD): a comprehensive meta-analysis of outcomes on parent-rated core symptomatology

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) impacts a significant number of children and adolescents and often leads to deleterious functional impairment. Psychostimulant medication has historically been the first line of pharmacological intervention, though recent years have seen greater attention paid to non-stimulant alternatives. The objective of the present study was to conduct the most comprehensive meta-analysis to date evaluating the efficacy of atomoxetine in reducing core symptomatology of ADHD according to parent report. Selection criteria were applied, and studies were located by searching electronic databases, review of reference sections, and contact with expert researchers; article searching began on 10/01/2013, and the final search was conducted on 09/01/2014. A total of 42 studies met inclusion criteria—33 with control groups and 9 without—for a total sample of 8398 individuals. For those receiving atomoxetine, the summary pre–post (e.g., standardized mean gain) effect size estimate was 1.37 (95% CI [1.24, 1.51], p < .001); atomoxetine was found to statistically significantly outperform control conditions overall (Z = 4.07, p < .001), though results differed by the type of control group; for instance, when comparing atomoxetine to alternative medications as controls, significant differences were no longer present. The non-stimulant atomoxetine led to significant improvement in core ADHD symptomatology and should be considered as a viable pharmacological treatment option for ADHD.

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Acknowledgements

The authors were not supported by any external funding for the completion of this study. There were no third-party sponsors involved at any stage of the project. The authors have confirmed that they have no competing or potential conflict of interest in relation to this work; neither author has any relationship with Eli Lilly and Company, Ltd, the manufacturer of atomoxetine. The authors appreciate the assistance of the many investigators whose correspondence provided needed data clarification which allowed more studies to be represented in this review.

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Gayleard, J.L., Mychailyszyn, M.P. Atomoxetine treatment for children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD): a comprehensive meta-analysis of outcomes on parent-rated core symptomatology. ADHD Atten Def Hyp Disord 9, 149–160 (2017). https://doi.org/10.1007/s12402-017-0216-y

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Keywords

  • Atomoxetine
  • ADHD
  • Children
  • Adolescents
  • Treatment
  • Meta-analysis