Amphetamines for Attention Deficit Hyperactivity Disorder (ADHD) in adults. Castells, X., Ramos-Quiroga, J. A., Bosch, R., Nogueira, M., & Casas, M. In Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 1996. 00002 ![Amphetamines for Attention Deficit Hyperactivity Disorder (ADHD) in adults [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex Background Background Attention Deficit Hyperactivity Disorder (ADHD) is a childhood onset disorder that can persist into adulthood. Amphetamines are used to treat adult ADHD, but uncertainties persist about their efficacy and safety. Objectives Objectives To examine the efficacy and safety of amphetamines for adults with ADHD, as well as the influence of dose, drug type and release formulation type. Search methods Search methods We searched CENTRAL, PubMed, EMBASE, CINAHL, PsycINFO, clinicaltrials.gov, UK Clinical Trials Gateway and references obtained from articles and experts in the field. We conducted the electronic searches on 25 February 2010. Selection criteria Selection criteria Randomized controlled trials comparing the efficacy of amphetamine derivatives against placebo or an active intervention. Data collection and analysis Data collection and analysis Two authors extracted data from each included study. We used the standardized mean difference (SMD) and the risk ratio (RR) to assess continuous and dichotomous outcomes, respectively. We conducted a stratified analysis to determine the influence of moderating variables. We assessed the trials for risk of bias and drew a funnel plot to investigate the possibility of publication bias. Main results Main results We included seven studies, which enrolled 1091 participants. All studies were placebo-controlled and three included an active comparator: guanfacine, modafinil and paroxetine. Most studies had short-term follow-up, with a mean study length of 8.1 weeks. Amphetamines improved ADHD symptom severity (SMD = -0.72; 95% CI -0.87 to -0.57) but did not improve retention in treatment overall and were associated with increased dropout due to adverse events (RR 3.03; 95% CI 1.52 to 6.05). The three amphetamine derivatives investigated (dextroamphetamine, lisdexamphetamine and mixed amphetamine salts (MAS)) were all efficacious for reducing ADHD symptoms, but MAS also increased retention in treatment. Different doses did not appear associated with differences in efficacy. We investigated immediate and sustained drug release formulations but found no difference between them on any outcome. When amphetamines were compared to other drug interventions, no differences were found. We did not find any study to be at low risk of bias overall, mainly because amphetamines have powerful subjective effects that may reveal the assigned treatment. Authors' conclusions Authors' conclusions Amphetamines improved short-term ADHD symptom severity. MAS also increased retention in treatment. Amphetamines were associated with higher attrition due to adverse events. The short study length and the restrictive inclusion criteria limit the external validity of these findings. Furthermore, the possibility that the results of the included studies were biased was high, which could have led to an overestimation of amphetamine efficacy.
@incollection{castells_amphetamines_1996,
title = {Amphetamines for {Attention} {Deficit} {Hyperactivity} {Disorder} ({ADHD}) in adults},
url = {http://dx.doi.org/10.1002/14651858.CD007813.pub2},
abstract = {Background Background Attention Deficit Hyperactivity Disorder (ADHD) is a
childhood onset disorder that can persist into adulthood. Amphetamines are
used to treat adult ADHD, but uncertainties persist about their efficacy
and safety. Objectives Objectives To examine the efficacy and safety of
amphetamines for adults with ADHD, as well as the influence of dose, drug
type and release formulation type. Search methods Search methods We
searched CENTRAL, PubMed, EMBASE, CINAHL, PsycINFO, clinicaltrials.gov, UK
Clinical Trials Gateway and references obtained from articles and experts
in the field. We conducted the electronic searches on 25 February 2010.
Selection criteria Selection criteria Randomized controlled trials
comparing the efficacy of amphetamine derivatives against placebo or an
active intervention. Data collection and analysis Data collection and
analysis Two authors extracted data from each included study. We used the
standardized mean difference (SMD) and the risk ratio (RR) to assess
continuous and dichotomous outcomes, respectively. We conducted a
stratified analysis to determine the influence of moderating variables. We
assessed the trials for risk of bias and drew a funnel plot to investigate
the possibility of publication bias. Main results Main results We included
seven studies, which enrolled 1091 participants. All studies were
placebo-controlled and three included an active comparator: guanfacine,
modafinil and paroxetine. Most studies had short-term follow-up, with a
mean study length of 8.1 weeks. Amphetamines improved ADHD symptom
severity (SMD = -0.72; 95\% CI -0.87 to -0.57) but did not improve
retention in treatment overall and were associated with increased dropout
due to adverse events (RR 3.03; 95\% CI 1.52 to 6.05). The three
amphetamine derivatives investigated (dextroamphetamine, lisdexamphetamine
and mixed amphetamine salts (MAS)) were all efficacious for reducing ADHD
symptoms, but MAS also increased retention in treatment. Different doses
did not appear associated with differences in efficacy. We investigated
immediate and sustained drug release formulations but found no difference
between them on any outcome. When amphetamines were compared to other drug
interventions, no differences were found. We did not find any study to be
at low risk of bias overall, mainly because amphetamines have powerful
subjective effects that may reveal the assigned treatment. Authors'
conclusions Authors' conclusions Amphetamines improved short-term ADHD
symptom severity. MAS also increased retention in treatment. Amphetamines
were associated with higher attrition due to adverse events. The short
study length and the restrictive inclusion criteria limit the external
validity of these findings. Furthermore, the possibility that the results
of the included studies were biased was high, which could have led to an
overestimation of amphetamine efficacy.},
booktitle = {Cochrane {Database} of {Systematic} {Reviews}},
publisher = {John Wiley \& Sons, Ltd},
author = {Castells, Xavier and Ramos-Quiroga, Josep Antoni and Bosch, Rosa and Nogueira, Mariana and Casas, Miguel},
year = {1996},
doi = {10.1002/14651858.CD007813.pub2},
note = {00002 },
keywords = {Sep 20 import, duplicate}
}
Downloads: 0
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Objectives Objectives To examine the efficacy and safety of amphetamines for adults with ADHD, as well as the influence of dose, drug type and release formulation type. Search methods Search methods We searched CENTRAL, PubMed, EMBASE, CINAHL, PsycINFO, clinicaltrials.gov, UK Clinical Trials Gateway and references obtained from articles and experts in the field. We conducted the electronic searches on 25 February 2010. Selection criteria Selection criteria Randomized controlled trials comparing the efficacy of amphetamine derivatives against placebo or an active intervention. Data collection and analysis Data collection and analysis Two authors extracted data from each included study. We used the standardized mean difference (SMD) and the risk ratio (RR) to assess continuous and dichotomous outcomes, respectively. We conducted a stratified analysis to determine the influence of moderating variables. We assessed the trials for risk of bias and drew a funnel plot to investigate the possibility of publication bias. Main results Main results We included seven studies, which enrolled 1091 participants. All studies were placebo-controlled and three included an active comparator: guanfacine, modafinil and paroxetine. Most studies had short-term follow-up, with a mean study length of 8.1 weeks. Amphetamines improved ADHD symptom severity (SMD = -0.72; 95% CI -0.87 to -0.57) but did not improve retention in treatment overall and were associated with increased dropout due to adverse events (RR 3.03; 95% CI 1.52 to 6.05). The three amphetamine derivatives investigated (dextroamphetamine, lisdexamphetamine and mixed amphetamine salts (MAS)) were all efficacious for reducing ADHD symptoms, but MAS also increased retention in treatment. Different doses did not appear associated with differences in efficacy. We investigated immediate and sustained drug release formulations but found no difference between them on any outcome. When amphetamines were compared to other drug interventions, no differences were found. We did not find any study to be at low risk of bias overall, mainly because amphetamines have powerful subjective effects that may reveal the assigned treatment. Authors' conclusions Authors' conclusions Amphetamines improved short-term ADHD symptom severity. MAS also increased retention in treatment. Amphetamines were associated with higher attrition due to adverse events. The short study length and the restrictive inclusion criteria limit the external validity of these findings. 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Amphetamines are\nused to treat adult ADHD, but uncertainties persist about their efficacy\nand safety. Objectives Objectives To examine the efficacy and safety of\namphetamines for adults with ADHD, as well as the influence of dose, drug\ntype and release formulation type. Search methods Search methods We\nsearched CENTRAL, PubMed, EMBASE, CINAHL, PsycINFO, clinicaltrials.gov, UK\nClinical Trials Gateway and references obtained from articles and experts\nin the field. We conducted the electronic searches on 25 February 2010.\nSelection criteria Selection criteria Randomized controlled trials\ncomparing the efficacy of amphetamine derivatives against placebo or an\nactive intervention. Data collection and analysis Data collection and\nanalysis Two authors extracted data from each included study. We used the\nstandardized mean difference (SMD) and the risk ratio (RR) to assess\ncontinuous and dichotomous outcomes, respectively. We conducted a\nstratified analysis to determine the influence of moderating variables. We\nassessed the trials for risk of bias and drew a funnel plot to investigate\nthe possibility of publication bias. Main results Main results We included\nseven studies, which enrolled 1091 participants. All studies were\nplacebo-controlled and three included an active comparator: guanfacine,\nmodafinil and paroxetine. Most studies had short-term follow-up, with a\nmean study length of 8.1 weeks. Amphetamines improved ADHD symptom\nseverity (SMD = -0.72; 95\\% CI -0.87 to -0.57) but did not improve\nretention in treatment overall and were associated with increased dropout\ndue to adverse events (RR 3.03; 95\\% CI 1.52 to 6.05). The three\namphetamine derivatives investigated (dextroamphetamine, lisdexamphetamine\nand mixed amphetamine salts (MAS)) were all efficacious for reducing ADHD\nsymptoms, but MAS also increased retention in treatment. Different doses\ndid not appear associated with differences in efficacy. We investigated\nimmediate and sustained drug release formulations but found no difference\nbetween them on any outcome. When amphetamines were compared to other drug\ninterventions, no differences were found. We did not find any study to be\nat low risk of bias overall, mainly because amphetamines have powerful\nsubjective effects that may reveal the assigned treatment. Authors'\nconclusions Authors' conclusions Amphetamines improved short-term ADHD\nsymptom severity. MAS also increased retention in treatment. Amphetamines\nwere associated with higher attrition due to adverse events. The short\nstudy length and the restrictive inclusion criteria limit the external\nvalidity of these findings. Furthermore, the possibility that the results\nof the included studies were biased was high, which could have led to an\noverestimation of amphetamine efficacy.},\n\tbooktitle = {Cochrane {Database} of {Systematic} {Reviews}},\n\tpublisher = {John Wiley \\& Sons, Ltd},\n\tauthor = {Castells, Xavier and Ramos-Quiroga, Josep Antoni and Bosch, Rosa and Nogueira, Mariana and Casas, Miguel},\n\tyear = {1996},\n\tdoi = {10.1002/14651858.CD007813.pub2},\n\tnote = {00002 },\n\tkeywords = {Sep 20 import, duplicate}\n}\n\n","author_short":["Castells, X.","Ramos-Quiroga, J. 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