Cochrane review urges caution when prescribing for ADHD
December 2 2015
Researchers have urged doctors to be cautious if considering prescribing methylphenidate for children or adolescents with attention deficit hyperactivity disorder (ADHD).
A Cochrane review has concluded that the drug may improve teacher-reported ADHD symptoms, teacher-reported general behaviour, and parent-reported quality of life among children and adolescents diagnosed with ADHD. “However, the low quality of the underpinning evidence means that we cannot be certain of the magnitude of the effects.”
The researchers assessed 38 parallel-group trials and 147 cross-over trials, representing over 12,200 patients, and found methylphenidate led to “modest” improvements in ADHD symptoms as a primary outcome. They also found there were improvements in general behaviour and quality of life. However, in all outcomes, the quality of the evidence was judged to be “very low”.
Data for serious adverse events was only reported in nine out of the 185 trials, meaning that while methylphenidate does not appear to be associated with an increased risk of serious adverse events, the quality of the evidence was again very low.
“It was apparent from assessing the included trials that it would have been possible for people involved in the trials to have been aware of which treatment the children were taking,” says Cochrane. “In addition, the reporting of results was not complete in many of the trials, and for some analyses there was variation among trial results.
“Based upon this information, the researchers urge clinicians to be cautious in prescribing methylphenidate, and to weigh up the benefits and risks more carefully.”
Professor Ole Jakob Storebø, a clinical psychologist from the Psychiatric Research Unit in Region Zealand, Denmark, led the team of 18 researchers carrying out the meta-analysis. “This review highlights the need for long-term, large, better-quality randomized trials so that we can determine the average effect of this drug more reliably,” he said.
Co-author Camilla Groth MD added: “This review shows very limited quality evidence for the effects of methylphenidate on children and adolescents with ADHD. Some might benefit, but we still don’t know which patients will do so. Clinicians prescribing methylphenidate must take account of the poor quality of the evidence, monitor treatment carefully, and weigh up the benefits and adverse effects.”