Methylphenidate should be first choice ADHD drug in children, Lancet study concludes

For the short-term treatment of attention-deficit hyperactivity disorder in children, methylphenidate should be the first choice of treatment, while amphetamines should be used for adults who have the condition, according to a Lancet review.

Girl with attention deficit hyperactivity disorder

The preferred first-line treatment for attention-deficit hyperactivity disorder (ADHD) in children is methylphenidate, a review of the evidence has concluded[1]
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The research, which looked at evidence on the safety and efficacy of seven drugs used to treat the condition, also recommended that amphetamines should be the first choice in adults who have ADHD.

However, more evidence is needed on long-term effects of the drugs, and environmental modifications and other non-pharmacological treatments should be tried first, the researchers concluded in The Lancet Psychiatry on 7 August 2018.

In a large meta-analysis and systematic review, researchers looked at evidence from 133 double-blind randomised controlled trials — including 81 trials in children — for lisdexamfetamine, atomoxetine, bupropion, clonidine, guanfacine, methylphenidate and modafinil, compared with placebo over 12 weeks of treatment.

For the short-term treatment of ADHD, all of the drugs, except modafinil in adults, were more effective than placebo but were less effective and less tolerable in adults than children and adolescents, although it was unclear why.

Current guidelines on use of the drugs are inconsistent, the researchers pointed out.

The National Institute for Health and Care Excellence (NICE) already recommends methylphenidate as first-line drug treatment for children aged five years and over and young people with ADHD, with lisdexamfetamine and atomoxetine or guanfacine recommended as second and third options.

In adults, NICE recommends methylphenidate and lisdexamfetamine as first-line treatments, but other European guidelines recommend psychostimulants as first-line options with no distinctions.

Andrea Cipriani, study lead and associate lecturer in the department of psychiatry at the University of Oxford, UK, said medication could be an important tool for ADHD and the evidence showed these were safe and effective treatments in the short term.

“It’s important to note that the data available only allows us to compare the effectiveness at 12 weeks, when we know that both children and adults can be on these medications for longer,” he added.

New research should be funded urgently to assess the long-term effects of these drugs, the researchers concluded.

References

[1] Cortese S, Adamo N, Del Giovane C et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psych 2018. doi: 10.1016/ S2215-0366(18)30269-4)

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Citation
The Pharmaceutical Journal, August 2018;Online:DOI:10.1211/PJ.2018.20205303