Luan Ruiling, Mu Zhiling, Yue Fang, He Shaoying
Department of Pharmacy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
Department of Pediatrics, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
Front Psychiatry. 2017 Nov 13;8:229. doi: 10.3389/fpsyt.2017.00229. eCollection 2017.
Our study is an analysis of multiple publications involving assessing the comparable efficacy and tolerability of six interventions, which are lisdexamfetamine dimesylate (LDX), atomoxetine (ATX), methylphenidate (MPH), clonidine hydrochloride (CLON), guanfacine extended release (GXR), and bupropion, for young patients (6-18 years old) suffering from attention deficit hyperactivity disorder (ADHD).
A conventional meta-analysis (MA) was performed to give direct comparisons and a network meta-analysis (NMA) was used to show the combination of direct and indirect evidence. Ranking preference for all the interventions under a certain outcome was given by the surface of cumulative ranking curve area (SUCRA).
Overall, 15,025 participants from 73 studies were involved in our analysis. In the pairwise MA, LDX was associated with less withdrawal than ATX for lack of efficacy. MPH showed less effectiveness than LDX according to ADHD Rating Scale score. Based on the analysis of our NMA, significant results of efficacy that LDX is a competitive drug were observed when evaluating LDX in comparison with other drugs except for CLON. ATX and GXR presented higher rates of abdominal pain morbidity versus inactive treatment.
The stimulants LDX and MPH are still highly recommended because they are highly effective and are tolerated well by patients. Among the non-stimulants, CLON can be taken into consideration for its appreciable effectiveness and tolerability. ATX and GXR can be seen as moderate choices.
我们的研究是对多篇出版物进行分析，这些出版物涉及评估六种干预措施（即二甲磺酸赖右苯丙胺（LDX）、托莫西汀（ATX）、哌甲酯（MPH）、盐酸可乐定（CLON）、缓释胍法辛（GXR）和安非他酮）对患有注意力缺陷多动障碍（ADHD）的年轻患者（6至18岁）的疗效和耐受性的可比性。
进行传统的荟萃分析（MA）以进行直接比较，并使用网状荟萃分析（NMA）来展示直接证据和间接证据的结合。通过累积排序曲线面积（SUCRA）表面给出在特定结果下所有干预措施的排序偏好。
总体而言，我们的分析纳入了来自73项研究的15025名参与者。在成对荟萃分析中，LDX因疗效不佳而退出治疗的情况少于ATX。根据ADHD评定量表评分，MPH的效果不如LDX。基于我们的网状荟萃分析，在将LDX与除CLON之外的其他药物进行比较时，观察到LDX作为一种有竞争力药物的显著疗效结果。与非活性治疗相比，ATX和GXR出现腹痛的发病率更高。
仍然强烈推荐使用兴奋剂LDX和MPH，因为它们疗效显著且患者耐受性良好。在非兴奋剂中，CLON因其可观的疗效和耐受性可予以考虑。ATX和GXR可视为中等选择。
