Long-acting versus short-acting methylphenidate for paediatric ADHD: a systematic review and meta-analysis of
Salima Punja1, Liliane Zorzela, Lisa Hartling
1Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Insights
Long-acting methylphenidate shows modest benefits for pediatric ADHD symptoms based on parent reports, but short-acting forms are preferred by teachers for hyperactivity. Both formulations have similar adverse event profiles.
Area of Science:
- Pharmacology
- Neuroscience
- Pediatrics
Background:
- Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children.
- Methylphenidate is a first-line treatment for ADHD, available in short-acting and long-acting formulations.
- Understanding the comparative efficacy and safety of these formulations is crucial for optimal treatment.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of long-acting versus short-acting methylphenidate in pediatric ADHD.
- To compare outcomes based on different reporting perspectives (parents vs. teachers) and formulation generations.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) published between 1950 and 2012.
- Searched multiple electronic databases for relevant English-language studies.
- Included RCTs comparing long-acting and short-acting methylphenidate in children (<18 years) with ADHD.
Main Results:
- Meta-analysis of three studies using parent ratings showed long-acting methylphenidate favored for hyperactivity/impulsivity (SMD -0.30).
- Conversely, three studies using teacher ratings favored short-acting methylphenidate for hyperactivity (SMD 0.29).
- First-generation long-acting formulations (osmotic release oral system) showed efficacy for inattention/overactivity (SMD -0.35), while second-generation formulations were less effective than short-acting forms (SMD 0.42). Adverse events were slightly higher with long-acting forms.
Conclusions:
- Long-acting methylphenidate offers modest benefits for pediatric ADHD symptom severity, particularly according to parent reports.
- Teacher reports suggest a preference for short-acting methylphenidate in managing hyperactivity.
- Efficacy of long-acting formulations varies by generation, with first-generation showing better results than second-generation.
Objective:
To synthesise existing knowledge of the efficacy and safety of long-acting versus short-acting methylphenidate for paediatric attention deficit hyperactivity disorder (ADHD).
Design:
Systematic review and meta-analysis.
Data Sources:
Electronic literature search of CENTRAL, MEDLINE, PreMEDLINE, CINAHL, EMBASE, PsychINFO, Scopus and Web of Science for articles published in the English language between 1950 and 2012. Reference lists of included studies were checked for additional studies.
Study Selection:
Randomised controlled trials of paediatric ADHD patients (<18 years), comparing a long-acting methylphenidate form to a short-acting methylphenidate form.
Data Extraction:
Two authors independently selected trials, extracted data and assessed risk of bias. Continuous outcomes were compared using standardised mean differences (SMDs) between treatment groups. Adverse events were compared using risk differences between treatment groups. Heterogeneity was explored by subgroup analysis based on the type of long-acting formulation used.
Results:
Thirteen RCTs were included; data from 882 participants contributed to the analysis. Meta-analysis of three studies which used parent ratings to report on hyperactivity/impulsivity had an SMD of -0.30 (95% CI -0.51 to -0.08) favouring the long-acting forms. In contrast, three studies used teacher ratings to report on hyperactivity and had an SMD of 0.29 (95% CI 0.05 to 0.52) favouring the short-acting methylphenidate. In addition, subgroup analysis of three studies which used parent ratings to report on inattention/overactivity indicate that the osmotic release oral system generation long-acting formulation was favoured with an SMD of -0.35 (95% CI -0.52 to -0.17), while the second generation showed less efficacy than the short-acting formulation with an SMD of 0.42 (95% CI 0.17 to 0.68). The long-acting formulations presented with slightly more total reported adverse events (n=578) as compared with the short-acting formulation (n=566).
Conclusions:
The findings from this systematic review indicate that the long-acting forms have a modest effect on the severity of inattention/overactivity and hyperactivity/impulsivity according to parent reports, whereas the short-acting methylphenidate was preferred according to teacher reports for hyperactivity.
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