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

Systematic review and meta-analysis: effects of pharmacological treatment for attention-deficit/hyperactivity disorder on quality of life
Systematic review and meta-analysis: effects of pharmacological treatment for attention-deficit/hyperactivity disorder on quality of life
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.
1527-5418
Bellato, Alessio
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Perrott, Nadia J.
00cd0a0f-baf6-40f0-ba9b-e26d0a145486
Marzulli, Lucia
3f554484-1473-4d8b-b01c-1b01ba64c834
Parlatini, Valeria
6cdfb200-40ce-43ce-84da-dcb6eba0f67a
Coghill, David
deea8957-fdfc-488a-a3bb-fb9b536c7172
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Bellato, Alessio
0ee4c34f-3850-4883-8b82-5717b74990f7
Perrott, Nadia J.
00cd0a0f-baf6-40f0-ba9b-e26d0a145486
Marzulli, Lucia
3f554484-1473-4d8b-b01c-1b01ba64c834
Parlatini, Valeria
6cdfb200-40ce-43ce-84da-dcb6eba0f67a
Coghill, David
deea8957-fdfc-488a-a3bb-fb9b536c7172
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb

Bellato, Alessio, Perrott, Nadia J., Marzulli, Lucia, Parlatini, Valeria, Coghill, David and Cortese, Samuele (2024) Systematic review and meta-analysis: effects of pharmacological treatment for attention-deficit/hyperactivity disorder on quality of life. Journal of the American Academy of Child & Adolescent Psychiatry. (doi:10.1016/j.jaac.2024.05.023).

Record type: Article

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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Accepted/In Press date: 15 May 2024
e-pub ahead of print date: 30 May 2024
Published date: 30 May 2024

Identifiers

Local EPrints ID: 490765
URI: http://eprints.soton.ac.uk/id/eprint/490765
ISSN: 1527-5418
PURE UUID: ce5494b1-512a-40e1-88b7-45ad35ce689f
ORCID for Alessio Bellato: ORCID iD orcid.org/0000-0001-5330-6773
ORCID for Valeria Parlatini: ORCID iD orcid.org/0000-0002-4754-2494
ORCID for Samuele Cortese: ORCID iD orcid.org/0000-0001-5877-8075

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Date deposited: 06 Jun 2024 16:38
Last modified: 10 Sep 2024 02:09

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Contributors

Author: Alessio Bellato ORCID iD
Author: Nadia J. Perrott
Author: Lucia Marzulli
Author: Valeria Parlatini ORCID iD
Author: David Coghill
Author: Samuele Cortese ORCID iD

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