Systematic review and meta-analysis: effects of pharmacological treatment for attention-deficit/hyperactivity disorder on quality of life

Abstract

Objective: we conducted a systematic review and meta-analysis to quantify the effect of ADHD medication on QoL, and to understand if this effect differs between stimulants and non-stimulants.

Method: from the dataset of a published network meta-analysis (Cortese et al., 20181), updated on 27th February 2023 (https://med-adhd.org/), we identified randomized controlled trials (RCTs) of ADHD medications for individuals aged 6 or more with a diagnosis of ADHD based on DSM (from III to 5 editions) or ICD (9 or 10), reporting data on QoL (measured with a validated scale). The risk of bias for each RCTs was assessed using the Cochrane Risk of Bias tool 2. Multi-level meta-analytic models were conducted with R 4.3.1.

Results: we included 17 RCTs (5,388 participants in total; 56% randomized to active medication) in the meta-analyses. We found that amphetamines (Hedge’s g = 0.51, 95% CI = 0.08, 0.94), methylphenidate (0.38; 0.23, 0.54), and atomoxetine (0.30; 0.19, 0.40) were significantly more efficacious than placebo in improving QoL in people with ADHD, with moderate effect size. For atomoxetine, these effects were not moderated by the length of intervention, nor differed between children/adolescents and adults.

Discussion: in addition to being efficacious in reducing ADHD core symptoms’ severity, both stimulant and non-stimulant medications are efficacious in improving QoL in people with ADHD, albeit with lower effect sizes. Future research should explore whether and to what degree combining pharmacological and non-pharmacological interventions is likely to further improve QoL in people with ADHD.

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Identifiers

ORCID for Alessio Bellato: orcid.org/0000-0001-5330-6773

ORCID for Valeria Parlatini: orcid.org/0000-0002-4754-2494

ORCID for Samuele Cortese: orcid.org/0000-0001-5877-8075

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