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 .
Combined Stimulant and Guanfacine Administration in Attention-Deficit/Hyperactivity Disorder: A Controlled, Comparative Study.
OBJECTIVE Because models of attention-deficit/hyperactivity disorder ( ADHD ) therapeutics emphasize benefits of both enhanced dopaminergic and noradrenergic signaling , strategies to enhance D1 and α2A agonism may yield enhanced clinical and cognitive responses . This study tested the hypothesis that combined effects of a dopamine and noradrenergic agonist , d-methylpheni date extended-release ( DMPH ) with guanfacine ( GUAN ) , an α2A receptor agonist , would be clinical ly superior to either monotherapy and would have equal tolerability . METHOD An 8-week , double-blind , 3-arm , comparative trial r and omized 7- to 14-year-olds with DSM-IV ADHD to GUAN ( 1 - 3 mg/day ) , DMPH ( 5 - 20 mg/day ) , or a combination ( COMB )  with fixed-flexible dosing . Outcome measures were the ADHD Rating Scale IV ( ADHD-RS-IV ) and the Clinical Global Impression-Improvement ( CGI-I ) scale . Data on adverse events and safety measures were obtained . RESULTS A total of 207 participants were r and omized and received drug . Analyses showed significant treatment group main effects for ADHD-RS-IV ADHD total ( p = .0001 ) and inattentive symptoms ( p = .0001 ) . COMB demonstrated small but consistently greater reductions in ADHD-RS-IV Inattentive subscale scores versus monotherapies ( DMPH : p = .05 ; f(2 ) = .02 ; and GUAN : p = .02 ; f(2 ) = .02 ) , and was associated with a greater positive response rate by CGI-I ( p = .01 ) . No serious cardiovascular events occurred . Sedation , somnolence , lethargy , and fatigue were greater in both guanfacine groups . All treatments were well tolerated . CONCLUSION COMB showed consistent evidence of clinical benefits over monotherapies , possibly reflecting advantages of greater combined dopaminergic and α2A agonism . Adverse events were generally mild to moderate , and COMB treatment showed no differences in safety or tolerability . CLINICAL TRIAL REGISTRATION INFORMATION Single Versus Combination Medication Treatment for Children With Attention Deficit Hyperactivity Disorder ( Project1 ) ; http:// clinical trials.gov/ ; NCT00429273
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 .