On the CGI-I scale , the analysis revealed that MPH was more effective than ATX and GXR .
For any adverse events , RBX ( 89 % ) was the safest alternative .
Network meta- analysis offered a broader overview on the available treatments for ADHD , especially for safety issues , and contributes towards evidence gathering and clinical practice decisions .
The aim of this study is to gather evidence of head-to-head double-blind r and omized-controlled trials on the efficacy and safety of available treatments for attention deficit hyperactivity disorder ( ADHD ) in children and adolescents .
A double-blind, placebo-controlled trial of dexmethylphenidate hydrochloride and d,l-threo-methylphenidate hydrochloride in children with attention-deficit/hyperactivity disorder.
OBJECTIVE To evaluate the efficacy and safety of dexmethylpheni date hydrochloride ( d-MPH , Focalin ) for the treatment of attention-deficit/hyperactivity disorder ( ADHD ) and to test an a priori hypothesis that d-MPH would have a longer duration of action than d , l-threo-methylpheni date ( d , l-MPH ) . METHOD This was a r and omized , double-blind study conducted at 12 U.S. centers . One hundred thirty-two subjects received d-MPH ( n=44 ) , d , l-MPH ( n=46 ) , or placebo ( n=42 ) twice daily for 4 weeks , with titration of the dose based on weekly clinic visits . The primary efficacy variable was change from baseline to last study visit on teacher-completed Swanson , Nolan , and Pelham Rating Scale ( Teacher SNAP ) . Secondary efficacy measures included the change on parent-completed SNAP ( Parent SNAP ) , Clinical Global Impressions Scale-Improvement ( CGI-I ) score , and Math Test performance . Assessment s at home in late afternoon were included to test the hypothesis that d-MPH would have a longer duration of efficacy than d , l-MPH . Safety was assessed through monitoring occurrence and severity of adverse events and discontinuations related to them . RESULTS Treatment with either d-MPH ( p=.0004 ) or d , l-MPH ( p=.0042 ) significantly improved Teacher SNAP ratings compared with placebo . The d-MPH group showed significant improvements compared with placebo on the afternoon Parent SNAP ratings ( p=.0003 ) and scores on the Math Test ( p=.0236 ) obtained late in the afternoon at 6:00 p.m. Sixty-seven percent of patients showed improvement on d-MPH and 49 % on d , l-MPH based on CGI-I scores . Both d-MPH and d , l-MPH were well tolerated , no patient in the d-MPH group and only two patients each in the d , l-MPH and placebo groups discontinued the study . CONCLUSIONS For the treatment of ADHD , an average titrated dose of 18.25 mg/day of d-MPH is as efficacious and safe as an average titrated dose of 32.14 mg/day of d , l-MPH . Both active treatments have large effect sizes . Thus , d-MPH and d , l-MPH appear to provide similar efficacy , and d-MPH may have longer duration of action after twice-daily dosing , but additional studies are needed to determine the statistical and clinical significance of this possibility
On the CGI-I scale , the analysis revealed that MPH was more effective than ATX and GXR .
For any adverse events , RBX ( 89 % ) was the safest alternative .
Network meta- analysis offered a broader overview on the available treatments for ADHD , especially for safety issues , and contributes towards evidence gathering and clinical practice decisions .
The aim of this study is to gather evidence of head-to-head double-blind r and omized-controlled trials on the efficacy and safety of available treatments for attention deficit hyperactivity disorder ( ADHD ) in children and adolescents .