Extended-release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults
Kim Boesen1,2, Asger Sand Paludan-Müller3,4, Peter C Gøtzsche5
1Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health at Charité, QUEST Center for Responsible Research, Berlin, Germany.
The Cochrane Database of Systematic Reviews
|February 24, 2022
Summary
Extended-release methylphenidate shows small to moderate improvements in ADHD symptoms for adults, but evidence quality is very low. Benefits and harms remain uncertain due to trial limitations.
Area of Science:
- Pharmacological treatment of Attention Deficit Hyperactivity Disorder (ADHD).
- Central Nervous System (CNS) stimulant efficacy and safety in adults.
- Evidence-based medicine and systematic review methodology.
Background:
- Attention Deficit Hyperactivity Disorder (ADHD) is a common diagnosis in adults.
- Central Nervous System (CNS) stimulants like methylphenidate are first-line treatments.
- Uncertainty exists regarding the benefits and harms of methylphenidate in adults.
Purpose of the Study:
- To evaluate the beneficial and harmful effects of extended-release methylphenidate formulations.
- Focus on adults diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
- Assess outcomes including symptom improvement, functional status, and adverse events.
Main Methods:
- Systematic review and meta-analysis of randomized, double-blind, parallel-group trials.
- Searched multiple databases and trial registries up to February 2021.
- Assessed risk of bias and certainty of evidence using Cochrane and GRADE methodologies.
Main Results:
- Twenty-four trials involving 5066 participants were included.
- Very low-certainty evidence suggests methylphenidate improves ADHD symptoms (self-rated, investigator-rated, peer-rated) and quality of life.
- No significant effect on 'days missed at work' or serious adverse events; increased risk of any adverse event.
Conclusions:
- Extended-release methylphenidate demonstrated small-to-moderate improvements in ADHD symptoms.
- The certainty of evidence for all outcomes was rated as 'very low' due to high risk of bias and generalizability limitations.
- The overall benefits and harms of extended-release methylphenidate for adult ADHD remain uncertain.
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