title: Comparative efficacy and safety of methylphenidate and atomoxetine for attention-deficit hyperactivity disorder in children and adolescents: Meta-analysis based on head-to-head trials.
abstract: BACKGROUND
  Comparative efficacy and safety are important issues for appropriate drug selection for attention-deficit hyperactivity disorder (ADHD) treatment. Therefore we conducted a meta-analysis, where we compared atomoxetine (ATX) and methylphenidate (MPH) for ADHD treatment in children and adolescents.
  
  
  METHODS
  Literature retrieval was conducted in relevant databases from their inception to April 2016 to select head-to-head trials that compared ATX and MPH in children and adolescents. Outcomes like response rate, ADHD Rating Scale (ADHD-RS) score, and adverse events were compared between ATX and MPH treatments. The standardized mean difference (SMD) and risk ratio (RR) with their corresponding 95% confidence intervals (CIs) were used as the effect size for continuous data or dichotomous data, respectively.
  
  
  RESULTS
  Eleven eligible randomized-controlled trials were included, and two of them were double-blind, while the remaining were open-label. Compared to ATX, MPH showed a higher response rate (RR = 1.14, 95% CI [1. 09, 1.20]), decreased inattention (SMD = -0.13, 95% CI [-0.25, -0.01]) and lower risk of adverse events (drowsiness: RR = 0.17, 95% CI [0.11, 0.26; nausea: RR = 0.49; 95% CI [0.29, 0.85; vomiting: RR = 0.41, 95% CI [0.27, 0.63]). However, MPH presented a higher risk of insomnia than ATX (RR = 2.27, 95% CI [1.63, 3.15], p < .01).
  
  
  CONCLUSIONS
  Results of the meta-analysis add additional evidence of the effectiveness of both ATX and MPH and suggest that MPH should be a first treatment option in most patients with ADHD.
authors.affiliation: a Pediatrics Department , Shandong Provincial Hospital Affiliated to Shandong University, Shandong University , Jinan , China.|b Newborn Department , Linyi People's Hospital , Linyi , China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Liu
authors.affiliation: c Department of Pediatrics , Linyi Traditional Chinese Medical Hospital , Linyi , China.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhang
authors.affiliation: d Department of Pediatrics , The People's Hospital of Lanshan District , LinYi , China.
authors.forename: Qingqing
authors.initials: Q
authors.lastname: Fang
authors.affiliation: e Department of Pediatrics , Weishan County People's Hospital , Jining , China.
authors.forename: Lili
authors.initials: L
authors.lastname: Qin
mesh_terms: D000293:Adolescent; D000069445:Atomoxetine Hydrochloride / Q000009:adverse effects / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D000069445:Atomoxetine Hydrochloride
keywords: Adverse events; atomoxetine; attention-deficit hyperactivity disorder; guidelines; methylphenidate; response rate