title: How oppositionality, inattention, and hyperactivity affect response to atomoxetine versus methylphenidate: a pooled meta-analysis.
abstract: OBJECTIVE
  To assess how threshold oppositional defiant disorder (ODD), inattention, and hyperactivity-impulsivity affect the response to atomoxetine versus methylphenidate.
  
  
  METHODS
  Systematic review of randomized controlled trials (RCTs; ≥6 weeks follow-up). The primary measure was core symptom response-≥40% reduction in ADHD Rating Scale-IV-Parent Version: investigator administered and scored total or domain subscores, as appropriate.
  
  
  RESULTS
  Data from 1,391 children and adolescents (823 atomoxetine, 568 methylphenidate; 7 RCTs) were meta-analyzed. The mean difference in response rates for patients with ODD was 0.6% (95% confidence interval [CI] = -11.9%-13.1%). The "without ODD" patient group showed significant between-trial heterogeneity (p < .001). Response rate differences for patients meeting the threshold for inattention or hyperactivity-impulsivity were -3.1% (95% CI = -11.5%-5.3%) and -4.9% (95% CI = -14.3%-4.4%), respectively.
  
  
  CONCLUSIONS
  Meeting the threshold criteria for oppositionality, inattention, or hyperactivity-impulsivity did not alter core ADHD symptom response to atomoxetine versus methylphenidate, which was equivalent.
authors.affiliation: Eli Lilly Australia Pty Ltd, West Ryde, NSW, Australia. van_wyk_gregory_wayne@lilly.com
authors.forename: Gregory W
authors.initials: GW
authors.lastname: van Wyk
authors.forename: Philip L
authors.initials: PL
authors.lastname: Hazell
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kohn
authors.forename: Renee E
authors.initials: RE
authors.lastname: Granger
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Walton
mesh_terms: D000293:Adolescent; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D006948:Hyperkinesis / Q000188:drug therapy*; D008774:Methylphenidate / Q000627:therapeutic use*; D011437:Propylamines / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants; D011437:Propylamines; D008774:Methylphenidate; D000069445:Atomoxetine Hydrochloride