Sugaya Luisa S, Farhat Luis C, Califano Pietro, Polanczyk Guilherme V
Department of Psychiatry Faculdade de Medicina FMUSP Universidade de São Paulo São Paulo Brazil.
National Institute of Developmental Psychiatry (INPD) CNPq São Paulo Brazil.
JCPP Adv. 2023 Feb 25;3(3):e12146. doi: 10.1002/jcv2.12146. eCollection 2023 Sep.
Robust synthesis of evidence to support treatment recommendations for preschoolers with attention-deficit/hyperactivity disorder (ADHD) is lacking. The aim of this systematic review and meta-analysis was to review currently available evidence to evaluate the efficacy and acceptability of stimulants for preschool children with ADHD.
We searched electronic databases (CENTRAL, Embase, PubMed) from the database inception to March, 2022; and clinical trial registries through WHO ICTRP from the database inception to July, 2022, and selected double-blinded randomized controlled trials (RCTs) that compared stimulants against placebo for the treatment of preschoolers (age ≤ 7 years) with ADHD. Change in ADHD symptom severity was the primary outcome (efficacy) and all-cause dropout rates (acceptability) was the secondary outcome. Data were pooled with random-effects models weighted by the inverse of the variance. Risk of bias of individual studies were assessed with the Cochrane Risk of Bias tool version 2. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of evidence. This study is registered with PROSPERO (CRD42022348597).
Five RCTs (three methylphenidate immediate-release, one methylphenidate extended-release, and one lisdexamfetamine) were included. The analysis of efficacy was based on 489 participants. Meta-analysis of change in ADHD symptom severity demonstrated a significant effect in favor of stimulants over placebo (standardized mean difference = -0.59; 95% CI -0.77, -0.41; < 0.0001). There was no evidence of heterogeneity but some concerns about publication bias. Regardless, the confidence of evidence was considered moderate. For acceptability, stimulants did not lead to an increased rate of all-cause discontinuation rates in comparison to placebo (OR = 0.59; 95% CI 0.15, 2.37; = 0.45) but the confidence of estimate was very low.
Our findings demonstrated that stimulants are efficacious in reducing ADHD symptoms among preschool children. Clinicians should consider the use of stimulants when making treatment recommendations for preschoolers with ADHD.
缺乏有力的证据综合来支持针对注意力缺陷多动障碍（ADHD）学龄前儿童的治疗建议。本系统评价和荟萃分析的目的是回顾现有证据，以评估兴奋剂对患有ADHD的学龄前儿童的疗效和可接受性。
我们检索了从数据库建立至2022年3月的电子数据库（CENTRAL、Embase、PubMed）；并通过世界卫生组织国际临床试验注册平台检索了从数据库建立至2022年7月的临床试验注册库，选择了比较兴奋剂与安慰剂治疗学龄前（年龄≤7岁）ADHD儿童的双盲随机对照试验（RCT）。ADHD症状严重程度的变化是主要结局（疗效），全因脱落率（可接受性）是次要结局。数据采用方差倒数加权的随机效应模型进行合并。使用Cochrane偏倚风险工具第2版评估单个研究的偏倚风险。采用推荐分级评估、制定和评价方法评估证据质量。本研究已在国际前瞻性系统评价注册库（PROSPERO）注册（CRD42022348597）。
纳入了5项RCT（3项速释哌甲酯、1项缓释哌甲酯和1项赖右苯丙胺）。疗效分析基于489名参与者。ADHD症状严重程度变化的荟萃分析显示，与安慰剂相比，兴奋剂有显著疗效（标准化均数差=-0.59；95%CI -0.77，-0.4
