Table 5.
Efficacy and tolerability of MPH over the period of 12 weeks, as compared to placebo or other drugs used for ADHD in adults (adapted from Cortese et al. [2018])
| Comparator agent | Efficacy data | Tolerability data | ||
|---|---|---|---|---|
| SMD (95% CI) | Certainty of evidence* | OR (95% CI) | Certainty of evidence* | |
| Amphetamines | – 0.29 (from – 0.54 to – 0.05) | ⊕ ⊕ ◯◯ | 1.36 (0.54–3.43) | ⊕ ◯◯◯ |
| Atomoxetine | 0.04 (from – 0.14 to 0.23) | ⊕ ⊕ ⊕ ◯ | 0.97 (0.47–2.02) | ⊕ ⊕ ◯◯ |
| Bupropion | 0.04 (from – 0.38 to 0.45) | ⊕ ⊕ ◯◯ | 1.07 (0.13–8.92) | ⊕ ◯◯◯ |
| Modafinil | 0.65 (0.19–1.11) | ⊕ ⊕ ◯◯ | 0.60 (0.19–1.92) | ⊕ ◯◯◯ |
| Clonidine | No data available | No data available | ||
| Guanfacine | No data available | No data available | ||
| Placebo | 0.49 (0.35–0.64) |
⊕ ⊕ ⊕ ◯ moderate |
2.39 (1.40–4.08) | ⊕ ⊕ ⊕ ⊕ |
The primary outcomes for efficacy and tolerability were, respectively, the clinician-rated severity of ADHD core symptoms and the proportion of participants who left the study due to any adverse event. Results in bold are statistically significant
The respective SMD cut-off scores of 0.2, 0.5, and 0.8 denote small, moderate, and large clinical effects (Murad et al. 2014)
SMD > 0 favours MPH; OR > 0 favours comparator
* GRADE Working Group grades of evidence (cited verbatim from Balshem et al. [2011]):
High certainty (⊕ ⊕ ⊕ ⊕): We are very confident that the true value of outcome importance lies close to that of the estimate
Moderate certainty (⊕ ⊕ ⊕ ◯): We are moderately confident in the estimate: the true value of outcome importance is likely to be close to the estimate, but there is a possibility that it is substantially different
Low certainty (⊕ ⊕ ◯◯): Our confidence in the estimate is limited: the true value of outcome importance may be substantially different from the estimate
Very low certainty (⊕ ◯◯◯): We have very little confidence in the estimate: the true value of outcome importance is likely to be substantially different from the estimate
CI confidence interval, GRADE Grading of Recommendations Assessment, Development and Evaluation, MPH methylphenidate, OR odds ratio, SMD standardized mean difference