Modest Evidence for Methylphenidate in ADHD Amid Adverse Events
Review highlights need for long-term, large, better-quality randomized trials.
HealthDay News — Clinicians prescribing methylphenidate for treatment of attention-deficit/hyperactivity disorder (ADHD) in children and teens must weigh the benefits and adverse effects in the context of low-quality evidence, according to the authors of a review published online in The Cochrane Library.
Ole Jakob Storebø, PhD, from Region Zealand in Roskilde, Denmark, and colleagues examined the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. Data were included from 38 parallel-group trials (with 5,111 participants) and 147 crossover trials (7,134 participants).
The researchers found that methylphenidate may improve teacher-rated ADHD symptoms (standardized mean difference, −0.77; very low quality evidence). This corresponded to a mean difference of −9.6 points on the ADHD Rating Scale. Methylphenidate was not associated with an increase in serious adverse events (risk ratio, 0.98; 95 percent confidence interval, 0.44 to 2.22). Non-serious adverse events occurred in 526 per 1,000 participants prescribed methylphenidate compared with 408 per 1,000 in the control group (relative risk, 1.29; 95 percent confidence interval, 1.10 to 1.51).
Sleep problems and decreased appetite were the most common non-serious adverse events. There was an improvement in teacher-rated general behavior with methylphenidate and a suggestion that methylphenidate may improve parent-reported quality of life.
"The low quality of the underpinning evidence means that we cannot be certain of the magnitude of the effects," the authors write. "The findings highlight the urgent need for large randomized controlled trials of non-pharmacological treatments."
Storebø OJ. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Library. 2015; DOI: 10.1002/14651858.CD009885.pub2.