Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
BMJ Open. 2013 Mar 15;3(3):e002312. doi: 10.1136/bmjopen-2012-002312.
To synthesise existing knowledge of the efficacy and safety of long-acting versus short-acting methylphenidate for paediatric attention deficit hyperactivity disorder (ADHD).
Systematic review and meta-analysis.
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.
Randomised controlled trials of paediatric ADHD patients (<18 years), comparing a long-acting methylphenidate form to a short-acting methylphenidate form.
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.
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).
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.
综合长效和短效哌醋甲酯治疗儿童注意缺陷多动障碍（ADHD）的疗效和安全性现有知识。
系统评价和荟萃分析。
电子文献检索 CENTRAL、MEDLINE、PreMEDLINE、CINAHL、EMBASE、PsychINFO、Scopus 和 Web of Science，检索 1950 年至 2012 年间发表的英文文献。对纳入研究的参考文献列表进行检查，以查找其他研究。
比较长效哌醋甲酯制剂与短效哌醋甲酯制剂的儿科 ADHD 患者（<18 岁）的随机对照试验。
两名作者独立选择试验、提取数据并评估偏倚风险。使用治疗组之间的标准化均数差（SMD）比较连续结局。使用治疗组之间的风险差异比较不良反应。根据使用的长效制剂类型进行亚组分析以探索异质性。
纳入了 13 项 RCT；882 名参与者的数据用于分析。对使用家长评分报告多动/冲动的三项研究进行的荟萃分析显示，长效制剂组的 SMD 为-0.30（95%CI-0.51 至-0.08）。相比之下，使用教师评分报告多动的三项研究的 SMD 为 0.29（95%CI0.05 至 0.52），有利于短效哌醋甲酯。此外，使用家长评分报告注意力不集中/过度活动的三项研究的亚组分析表明，渗透型控释口服系统长效制剂具有优势，SMD 为-0.35（95%CI-0.52 至-0.17），而第二代与短效制剂相比疗效较差，SMD 为 0.42（95%CI0.17 至 0.68）。长效制剂报告的总不良反应（n=578）略多于短效制剂（n=566）。
本系统评价的结果表明，长效制剂在家长报告的注意力不集中/过度活动和多动/冲动严重程度方面具有适度的疗效，而短效哌醋甲酯在教师报告的多动方面更受欢迎。
