Comparative efficacy and tolerability of pharmacological interventions for attention-deficit/hyperactivity disorder in children, adolescents and adults: protocol for a systematic review and network meta-analysis.
- Cortese S Department of Psychology, Developmental Brain-Behaviour Laboratory, Academic Unit of Psychology, Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, and Solent NHS Trust, Southampton, UK.
- Adamo N MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Mohr-Jensen C Research Unit of Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark.
- Hayes AJ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
- Bhatti S Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
- Carucci S Child and Adolescent Neuropsychiatric Unit, 'A. Cao' Paediatric Hospital, 'G. Brotzu' Hospital Trust, Cagliari, Italy.
- Del Giovane C Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
- Atkinson LZ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
- Banaschewski T Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty, Central Institute of Mental Health, Mannheim/Heidelberg University, Mannheim, Germany.
- Simonoff E Institute of Psychiatry, Psychology and Neurosciences, King's College London, and the Maudsley Hospital, London, UK.
- Zuddas A Child and Adolescent Neuropsychiatric Unit, 'A. Cao' Paediatric Hospital, 'G. Brotzu' Hospital Trust, Cagliari, Italy.
- Barbui C Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy.
- Purgato M Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy.
- Steinhausen HC Department of Child and Adolescent Psychiatry, Psychiatric University Clinic Zurich, Switzerland.
- Shokraneh F Cochrane Schizophrenia Group, Institute of Mental Health, a Partnership between the University of Nottingham and Nottinghamshire Healthcare NHS Trust, UK.
- Xia J Cochrane Schizophrenia Group, Institute of Mental Health, a Partnership between the University of Nottingham and Nottinghamshire Healthcare NHS Trust, UK.
- Cipriani A Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
- Coghill D Division of Neuroscience, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
- 2017-01-12
Published in:
- BMJ open. - 2017
Attention-Deficit/Hyperactivity Disorder
acute treatment
network meta-analysis
pharmacological treatment
systematic review
Adolescent
Adrenergic alpha-2 Receptor Agonists
Adult
Attention Deficit Disorder with Hyperactivity
Bupropion
Central Nervous System Stimulants
Child
Clinical Protocols
Clonidine
Dose-Response Relationship, Drug
Humans
Methylphenidate
Network Meta-Analysis
Treatment Outcome
English
INTRODUCTION
Attention-deficit/hyperactivity disorder (ADHD) is a major public health issue. Pharmacological treatments play an important role in the multimodal treatment of ADHD. Currently, there is a lack of up-to-date and comprehensive evidence on how available ADHD drugs compare and rank in terms of efficacy and tolerability, in children or adolescents as well as in adults. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs), to rank pharmacological treatments for ADHD according to their efficacy and tolerability profiles.
METHODS AND ANALYSIS
We will search a broad range of electronic databases, including PubMed, MEDLINE, EMBASE, PsycINFO, ERIC and Web of Science, with no date or language restrictions. We will also search for unpublished studies using international clinical trial registries and contacting relevant drug companies. We will identify and include available parallel-group, cross-over and cluster randomised trials that compare methylphenidate, dexmethylphenidate, amphetamine derivatives (including lisdexamfetamine), atomoxetine, clonidine, guanfacine, bupropion or modafinil (as oral therapy) either with each other or to placebo, in children, adolescents or adults with ADHD. Primary outcomes will be efficacy (indicated by reduction in severity of ADHD core symptoms measured on a standardised scale) and tolerability (the proportion of patients who left a study early due to side effects). Secondary outcomes will be global functioning, acceptability (proportion of patients who left the study early by any cause) and changes in blood pressure and body weight. NMA will be conducted in STATA within a frequentist framework. The quality of RCTs will be evaluated using the Cochrane risk of bias tool, and the quality of the evidence will be assessed using the GRADE approach. Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings.
ETHICS AND DISSEMINATION
No ethical issues are foreseen. Results from this study will be published in a peer-reviewed journal and possibly presented at relevant national and international conferences.
TRIAL REGISTRATION NUMBER
CRD42014008976.
Attention-deficit/hyperactivity disorder (ADHD) is a major public health issue. Pharmacological treatments play an important role in the multimodal treatment of ADHD. Currently, there is a lack of up-to-date and comprehensive evidence on how available ADHD drugs compare and rank in terms of efficacy and tolerability, in children or adolescents as well as in adults. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs), to rank pharmacological treatments for ADHD according to their efficacy and tolerability profiles.
METHODS AND ANALYSIS
We will search a broad range of electronic databases, including PubMed, MEDLINE, EMBASE, PsycINFO, ERIC and Web of Science, with no date or language restrictions. We will also search for unpublished studies using international clinical trial registries and contacting relevant drug companies. We will identify and include available parallel-group, cross-over and cluster randomised trials that compare methylphenidate, dexmethylphenidate, amphetamine derivatives (including lisdexamfetamine), atomoxetine, clonidine, guanfacine, bupropion or modafinil (as oral therapy) either with each other or to placebo, in children, adolescents or adults with ADHD. Primary outcomes will be efficacy (indicated by reduction in severity of ADHD core symptoms measured on a standardised scale) and tolerability (the proportion of patients who left a study early due to side effects). Secondary outcomes will be global functioning, acceptability (proportion of patients who left the study early by any cause) and changes in blood pressure and body weight. NMA will be conducted in STATA within a frequentist framework. The quality of RCTs will be evaluated using the Cochrane risk of bias tool, and the quality of the evidence will be assessed using the GRADE approach. Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings.
ETHICS AND DISSEMINATION
No ethical issues are foreseen. Results from this study will be published in a peer-reviewed journal and possibly presented at relevant national and international conferences.
TRIAL REGISTRATION NUMBER
CRD42014008976.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1136/bmjopen-2016-013967
- PMID 28073796
- Persistent URL
- https://folia.unifr.ch/global/documents/128276
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