title: A network meta-analysis of atomoxetine and osmotic release oral system methylphenidate in the treatment of attention-deficit/hyperactivity disorder in adult patients.
abstract: The lack of head-to-head clinical studies powered to compare atomoxetine and osmotic release oral system (OROS) methylphenidate necessitates treatment comparison by methods that include indirect evidence such as network meta-analysis (NMA). A NMA assessing the relative treatment effects of atomoxetine and OROS methylphenidate in adults with attention-deficit/hyperactivity disorder (ADHD) was conducted. Studies were identified by systematic literature review. Analyses summarised improvements in efficacy, measured by ADHD-specific scales, using Cohen'sdto calculate the standardised mean difference (SMD), and all cause discontinuations. Results showed effect sizes (SMD, 95% credible interval (CrI)) relative to placebo that did not differ significantly between atomoxetine (0.46, 0.36-0.56) and OROS methylphenidate (0.51, 0.40-0.63) in clinical studies of up to 12 weeks' duration (SMD, 95% CrI for atomoxetine versus OROS methylphenidate: -0.05, -0.18-0.08). Patients treated with these medications responded better than those given placebo across all analyses. There was also no significant difference in discontinuation rates between atomoxetine and OROS methylphenidate (odds ratio, 95% CrI: 0.85, 0.53-1.35). Between-study heterogeneity was low overall. Results of this NMA suggest that the efficacy of atomoxetine and OROS methylphenidate in adults does not differ significantly. Clinical guidelines may require amendment to reflect these recent data.
authors.affiliation: Eli Lilly, Windlesham, UK bushe_chris@lilly.com.
authors.forename: Chris
authors.initials: C
authors.lastname: Bushe
authors.affiliation: Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Day
authors.affiliation: Eli Lilly, Windlesham, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Reed
authors.affiliation: Eli Lilly, Windlesham, UK.
authors.forename: Kristina
authors.initials: K
authors.lastname: Karlsdotter
authors.affiliation: Eli Lilly, Bad Homburg, Germany.
authors.forename: Lovisa
authors.initials: L
authors.lastname: Berggren
authors.affiliation: Real-World Evidence Solutions, IMS Health, London, UK.
authors.forename: Ashley
authors.initials: A
authors.lastname: Pitcher
authors.affiliation: Eli Lilly, Windlesham, UK.
authors.forename: Foula
authors.initials: F
authors.lastname: Televantou
authors.affiliation: Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, USA.
authors.forename: Virginia
authors.initials: V
authors.lastname: Haynes
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D000328:Adult; D000069445:Atomoxetine Hydrochloride / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D006801:Humans; D008774:Methylphenidate / Q000627:therapeutic use*
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D000069445:Atomoxetine Hydrochloride
keywords: Atomoxetine; adult; attention-deficit/hyperactivity disorder; meta-analysis; osmotic release oral system methylphenidate