Cortese Samuele
Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
Solent NHS Trust, Southampton, UK.
Expert Opin Pharmacother. 2023 Mar;24(4):425-434. doi: 10.1080/14656566.2023.2169604. Epub 2023 Jan 21.
A large number of randomized controlled trials (RCTs) and observational studies on the pharmacotherapy of ADHD are available.
Based on a search in PubMed and PsycInfo (up to 15 September 2022), this review addresses to which extent this body of research is currently able to inform routine prescribing practice, in terms of the choice of medication, titration strategy, augmentation treatments, and use of alternative, non-approved treatments.
A growing body of evidence is informing prescribers on some, but certainly not all, aspects related to the pharmacological treatment of ADHD in the daily clinical practice, with important weaknesses/gaps that need to be addressed. First, evidence synthesis of RCTs is not able to inform decision-making at the individual patient level. Second, the maximum safe and effective doses, possibly beyond those currently recommended, are not well understood. Third, evidence from RCTs on augmenting strategies is still limited. Fourth, no novel agents with the same or higher effect size of stimulants, in terms of efficacy, but with better tolerability and lower abuse potential, have been found. Implementation of precision psychiatry approaches and stratification of patients in future RCTs will be key to, respectively, individualize the treatment strategies and test etiopathophysiology-based agents.
现有大量关于注意力缺陷多动障碍（ADHD）药物治疗的随机对照试验（RCT）和观察性研究。
基于对PubMed和PsycInfo（截至2022年9月15日）的检索，本综述探讨了这一研究主体目前在多大程度上能够为常规处方实践提供信息，包括药物选择、滴定策略、增效治疗以及替代的、未获批准治疗方法的使用。
越来越多的证据正在就日常临床实践中与ADHD药物治疗相关的一些（但肯定不是全部）方面为处方者提供信息，存在需要解决的重要弱点/差距。首先，RCT的证据综合无法为个体患者层面的决策提供信息。其次，最大安全有效剂量（可能超过目前推荐的剂量）尚未得到充分了解。第三，关于增效策略的RCT证据仍然有限。第四，尚未发现具有与兴奋剂相同或更高效应大小、在疗效方面相当但耐受性更好且滥用潜力更低的新型药物。在未来的RCT中实施精准精神病学方法和患者分层将分别是使治疗策略个体化和测试基于病因病理生理学的药物的关键。
