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Metilfenidat s produljenim otpuštanjem za poremećaj s nedostatkom pažnje i hiperaktivnošću (ADHD) u odraslih

Appendices

Appendix 1. Search strategies (databases)

Cochrane Central Register of Controlled Trials (CENTRAL)

Searched 3 October 2017 [1477 records]
Searched 12 March 2019 [114 new records]
Searched 16 February 2021 [147 new records]

#1[mh "attention deficit and disruptive behavior disorders"]
#2[mh "attention deficit disorder with hyperactivity"]
#3[mh "conduct disorder"]
#4ADHD or ADHS or ADDH or AD next HD or HKD or TDAH
#5((attention* or behav*) near/3 (defic* or dysfunc* or disorder*))
#6((disrupt* near/3 disorder*) or (disrupt* near/3 behav*) or (defian* near/3 disorder*) or (defian* near/3 behav*))
#7(impulsiv* or inattentiv* or inattention*)
#8[mh hyperkinesis]
#9(hyperkin* or hyper‐kin* or hkd)
#10(minimal near/3 brain near/3 (disorder* or dysfunct* or damage*))
#11(hyperactiv* or hyper‐activ*)
#12{or #1‐#11}
#13[mh methylphenidate]
#14(Adaphen* or Aptensio* or Aradix* or Attenade* or Biphentin* or Calocain* or Centedrin* or Concerta* or Conmet* or Daytrana* or Dexmethylphenidat* or Difumenil* or D‐methylphenidat* or Equasym* or Fenilidato* or Focalin* or Matoride* or Medicebran* or Medikid* or Medikinet* or Meridil* or Metadate* or Methylphenidylacetat* or methyl NEXT phenidylacetat* or Methylofenidan* or Methylin* or Methypatch or methylphenidat* or Metilfenidato* or Phenidylate or Phenidyl hydrochlorid* or Phenidylhydrochlorid* or Quillivant* or Richter Works or Riphenidat* or Ritalin* or Ritrocel* or Rubifen* or Tsentedrin*)
#15#13 or #14
#16    #12 and #15 in Trials    
#17    #12 and #15 with Publication Year from 2017 to 2019, in Trials   
#18    #12 and #15 with Publication Year from 2019 to 2021, in Trials    

MEDLINE Ovid

Searched 3 October 2017 [1467 records]
Searched 12 March 2019 [97 new records]
Searched 15 February 2021 [99 new records]

1 "attention deficit and disruptive behavior disorders"/
2 attention deficit disorder with hyperactivity/
3 conduct disorder/
4 ADHD.tw,kf.
5 ADHS.tw,kf.
6 ADDH.tw,kf.
7 ("AD/HD" or hkd).tw,kf.
8 TDAH.tw,kf.
9 ((attention$ or behav$) adj3 (defic$ or dysfunc$ or disorder$)).tw,kf. (49848)
10 ((disrupt$ adj3 disorder$) or (disrupt$ adj3 behav$) or (defian$ adj3 disorder$) or (defian$ adj3 behav$)).tw,kf
11 (impulsiv$ or inattentiv$ or inattention$).tw,kf.
12 hyperkinesis/
13 (hyperkin$ or hyper‐kin$).tw,kf. (4266)
14 (minimal adj3 brain adj3 (disorder$ or dysfunct$ or damage$)).tw,kf.
15 (hyperactiv$ or hyper‐activ$).tw,kf.
16 or/1‐15
17 exp Methylphenidate/
18 Adaphen$.mp.
19 Aptensio$.mp.
20 Aradix$.mp.
21 Attenade$.mp.
22 Biphentin$.mp.
23 Calocain$.mp.
24 Centedrin$.mp.
25 Concerta$.mp.
26 Conmet$.mp.
27 Daytrana$.mp.
28 Dexmethylphenidat$.mp.
29 Difumenil$.mp.
30 D‐methylphenidat$.mp.
31 Equasym$.mp.
32 Fenilidato$.mp.
33 Focalin$.mp.
34 Matoride$.mp.
35 Medicebran$.mp.
36 Medikid$.mp.
37 Medikinet$.mp.
38 Meridil$.mp.
39 Metadate$.mp.
40 (Methylphenidylacetat$ or methyl phenidylacetat$).mp.
41 Methylofenidan$.mp.
42 Methylin$.mp.
43 Methypatch.mp.
45 Metilfenidato$.mp.
44 methylphenidat$.mp.
46 Novo‐Methylphenidat$.mp.
47 Phenidylate.mp.
48 (Phenidyl hydrochlorid$ or Phenidylhydrochlorid$).mp.
49 Quillivant$.mp.
50 Richter Works.mp.
51 Riphenidat$.mp.
52 Ritalin$.mp.
53 Ritrocel$.mp.
54 Rubifen$.mp.
55 Tsentedrin$.mp.
56 or/17‐55
57 16 and 56
58 randomized controlled trial.pt.
59 controlled clinical trial.pt.
60 randomized.ab.~
61 placebo.ab.
62 clinical trials as topic.sh.
63 randomly.ab.
64 trial.ti.
65 or/58‐64
66 exp animals/ not humans.sh.
67 65 not 66
68 57 and 67
69 (201710* or 201711* or 201712* or 2018* or 2019* ).dt,ez,da,ed.70  68 and 69
71  (201902* or 201903* or 201904* or 201905* or 201906* or 201907* or 201908* or 201909* or 201910* or 201911* or 201912* or 2020* or 2021*).dt,ez,da,ed. 
72     68 and 70 

MEDLINE In_Process and Other Non‐indexed Citations OVID

Searched 3 October 2017 [126 records]
Searched 13 March 2019 [66 new records]
Searched 15 February 2021 [53 new records]

1 ADHD.tw,kf.
2 ADHS.tw,kf.
3 ADDH.tw,kf.
4 ("AD/HD" or hkd).tw,kf.
5 TDAH.tw,kf.
6 ((attention$ or behav$) adj3 (defic$ or dysfunc$ or disorder$)).tw,kf.
7 ((disrupt$ adj3 disorder$) or (disrupt$ adj3 behav$) or (defian$ adj3 disorder$) or (defian$ adj3 behav$)).tw,kf.
8 (impulsiv$ or inattentiv$ or inattention$).tw,kf.
9 (hyperkin$ or hyper‐kin$).tw,kf.
10 (minimal adj3 brain adj3 (disorder$ or dysfunct$ or damage$)).tw,kf.
11 (hyperactiv$ or hyper‐activ$).tw,kf.
12 or/1‐11
13 Adaphen$.mp.
14 Aptensio$.mp.
15 Aradix$.mp.
16 Attenade$.mp.
17 Biphentin$.mp.
18 Calocain$.mp.
19 Centedrin$.mp.
20 Concerta$.mp.
21 Conmet$.mp.
22 Daytrana$.mp.
23 Dexmethylphenidat$.mp.
24 Difumenil$.mp.
25 D‐methylphenidat$.mp.
26 Equasym$.mp.
27 Fenilidato$.mp.
28 Focalin$.mp.
29 Matoride$.mp.
30 Medicebran$.mp.
31 Medikid$.mp.
32 Medikinet$.mp.
33 Meridil$.mp.
34 Metadate$.mp.
35 (Methylphenidylacetat$ or methyl phenidylacetat$).mp.
36 Methylofenidan$.mp.
37 Methylin$.mp.
38 Methypatch.mp.
39 methylphenidat$.mp.
40 Metilfenidato$.mp.
41 Novo‐Methylphenidat$.mp.
42 Phenidylate.mp.
43 (Phenidyl hydrochlorid$ or Phenidylhydrochlorid$).mp.
44 Quillivant$.mp.
45 Richter Works.mp.
46 Riphenidat$.mp.
47 Ritalin$.mp.
48 Ritrocel$.mp.
49 Rubifen$.mp.
50 Tsentedrin$.mp.
51 or/13‐50
52 random$.tw,kf.
53 placebo.ab.
54 trial.ti.
55 RCT.tw,kf.
56 or/52‐55
57 12 and 51 and 56

MEDLINE E‐Pub Ahead of Print (OVID)

Searched 3 October 2017 [27 records]
Searched 13 March 2019 [13 new records]
Searched 15 February 2021 [22 new records]

1 ADHD.tw,kf.
2 ADHS.tw,kf.
3 ADDH.tw,kf.
4 ("AD/HD" or hkd).tw,kf.
5 TDAH.tw,kf.
6 ((attention$ or behav$) adj3 (defic$ or dysfunc$ or disorder$)).tw,kf.
7 ((disrupt$ adj3 disorder$) or (disrupt$ adj3 behav$) or (defian$ adj3 disorder$) or (defian$ adj3 behav$)).tw,kf.
8 (impulsiv$ or inattentiv$ or inattention$).tw,kf.
9 (hyperkin$ or hyper‐kin$).tw,kf
10 (minimal adj3 brain adj3 (disorder$ or dysfunct$ or damage$)).tw,kf.
11 (hyperactiv$ or hyper‐activ$).tw,kf.
12 or/1‐11
13 Adaphen$.mp.
14 Aptensio$.mp.
15 Aradix$.mp.
16 Attenade$.mp.
17 Biphentin$.mp.
18 Calocain$.mp.
19 Centedrin$.mp.
20 Concerta$.mp.
21 Conmet$.mp.
22 Daytrana$.mp.
23 Dexmethylphenidat$.mp.
24 Difumenil$.mp.
25 D‐methylphenidat$.mp.
26 Equasym$.mp.
27 Fenilidato$.mp.
28 Focalin$.mp.
29 Matoride$.mp.
30 Medicebran$.mp.
31 Medikid$.mp.
32 Medikinet$.mp.
33 Meridil$.mp.
34 Metadate$.mp.
35 (Methylphenidylacetat$ or methyl phenidylacetat$).mp.
36 Methylofenidan$.mp.
37 Methylin$.mp.
38 Methypatch.mp.
39 methylphenidat$.mp.
40 Metilfenidato$.mp.
41 Novo‐Methylphenidat$.mp.
42 Phenidylate.mp.
43 (Phenidyl hydrochlorid$ or Phenidylhydrochlorid$).mp.
44 Quillivant$.mp.
45 Richter Works.mp.
46 Riphenidat$.mp.
47 Ritalin$.mp.
48 Ritrocel$.mp.
49 Rubifen$.mp.
50 Tsentedrin$.mp.
51 or/13‐50
52 random$.tw,kf.
53 placebo.ab.
54 trial.ti.
55 RCT.tw,kf.
56 or/52‐55
57 12 and 51 and 56

Embase Ovid strategy up to 2019

Searched 2 October 2017 [2687 records]
Searched 15 March 2019 [187 new records]

1 attention deficit disorder/
2 hyperactivity/
3 conduct disorder/
4 ADHD.tw,kw.
5 ADDH.tw,kw.
6 ADHS.tw,kw.
7 ("AD/HD" or HKD).tw,kw.
8 TDAH.tw,kw.
9 ((attention$ or behav$) adj3 (defic$ or dysfunc$ or disorder$)).tw,kw.
10 ((disrupt$ adj3 disorder$) or (disrupt$ adj3 behav$) or (defian$ adj3 disorder$) or (defian$ adj3 behav$)).tw,kw.
11 (impulsiv$ or inattentiv$ or inattention$).tw,kw.
12 hyperkinesis/
13 (hyperkin$ or hyper‐kin$ or hkd).tw,kw.
14 (minimal adj3 brain adj3 (disorder$ or dysfunct$ or damage$)).tw.
15 (hyperactiv$ or hyper‐activ$).tw.
16 or/1‐15
17 methylphenidate/
18 (Adaphen$ or Aptensio$ or Aradix$ or Attenade$ or Biphentin$).mp.
19 methylphenidate/
20 (Adaphen$ or Aptensio$ or Aradix$ or Attenade$ or Biphentin$ or Calocain$ or Centedrin$ or Concerta$ or Conmet$ or Daytrana$ or Dexmethylphenidat$ or Difumenil$ or D‐methylphenidat$ or Equasym$ or Fenilidato$ or Focalin$ or Matoride$ or Medicebran$ or Medikid$ or Medikinet$ or Meridil$ or Metadate$ or Methylphenidylacetat$ or methyl phenidylacetat$ or Methylofenidan$ or Methylin$ or Methypatch or methylphenidat$ or Metilfenidato$ or Phenidylate or Phenidyl hydrochlorid$ or Phenidylhydrochlorid$ or Quillivant$ or Ritcher Works or Riphenidat$ or Ritalin$ or Ritrocel$ or Rubifen$ or Tsentedrin$).mp.
21 19 or 20
22 16 and 21
23 limit 22 to "therapy (best balance of sensitivity and specificity)"
24 remove duplicates from 23
25 limit 24 to yr="2017 ‐Current"

Embase Ovid Strategy 2021 

Searched 15 February 2021 [271 new records]
1     attention deficit disorder/ 
2     hyperactivity/ 
3     conduct disorder/ 
4     ADHD.tw,kw. 
5     ADDH.tw,kw. 
6     ADHS.tw,kw. 
7     ("AD/HD" or HKD).tw,kw. 
8     TDAH.tw,kw. 
9     ((attention$ or behav$) adj3 (defic$ or dysfunc$ or disorder$)).tw,kw.
10     ((disrupt$ adj3 disorder$) or (disrupt$ adj3 behav$) or (defian$ adj3 disorder$) or (defian$ adj3 behav$)).tw,kw.
11     (impulsiv$ or inattentiv$ or inattention$).tw,kw. 
12     hyperkinesis/ 
13     (hyperkin$ or hyper‐kin$ or hkd).tw,kw. 
14     (minimal adj3 brain adj3 (disorder$ or dysfunct$ or damage$)).tw,kw. 
15     (hyperactiv$ or hyper‐activ$).tw,kw. 
16     or/1‐15 
17     methylphenidate/ 
18     (Adaphen$ or Aptensio$ or Aradix$ or Attenade$ or Biphentin$).mp. 
19     methylphenidate/ 
20     (Adaphen$ or Aptensio$ or Aradix$ or Attenade$ or Biphentin$ or Calocain$ or Centedrin$ or Concerta$ or Conmet$ or Daytrana$ or Dexmethylphenidat$ or Difumenil$ or D‐methylphenidat$ or Equasym$ or Fenilidato$ or Focalin$ or Matoride$ or Medicebran$ or Medikid$ or Medikinet$ or Meridil$ or Metadate$ or Methylphenidylacetat$ or methyl phenidylacetat$ or Methylofenidan$ or Methylin$ or Methypatch or methylphenidat$ or Metilfenidato$ or Phenidylate or Phenidyl hydrochlorid$ or Phenidylhydrochlorid$ or Quillivant$ or Ritcher Works or Riphenidat$ or Ritalin$ or Ritrocel$ or Rubifen$ or Tsentedrin$).mp. 
21     19 or 20 
22     16 and 21 (
23     Randomized controlled trial/ 
24     Controlled clinical study/ 
25     random$.ti,ab. 
26     randomization/
27     intermethod comparison/ 
28     placebo.ti,ab. 
29     (compare or compared or comparison).ti.
30     ((evaluated or evaluate or evaluating or assessed or assess) and (compare or compared or comparing or comparison)).ab. 
31     (open adj label).ti,ab. 
32     ((double or single or doubly or singly) adj (blind or blinded or blindly)).ti,ab. 
33     double blind procedure/ 
34     parallel group$1.ti,ab. 
35     (crossover or cross over).ti,ab.
36     ((assign$ or match or matched or allocation) adj5 (alternate or group$1 or intervention$1 or patient$1 or subject$1 or participant$1)).ti,ab. (
37     (assigned or allocated).ti,ab. 
38     (controlled adj7 (study or design or trial)).ti,ab.
39     (volunteer or volunteers).ti,ab. 
40     human experiment/
41     trial.ti. 
42     or/23‐41 
43     (random$ adj sampl$ adj7 ("cross section$" or questionnaire$1 or survey$ or database$1)).ti,ab. not (comparative study/ or controlled study/ or randomi?ed controlled.ti,ab. or randomly assigned.ti,ab.) 
44     Cross‐sectional study/ not (randomized controlled trial/ or controlled clinical study/ or controlled study/ or randomi?ed controlled.ti,ab. or control group$1.ti,ab.) 
45     (((case adj control$) and random$) not randomi?ed controlled).ti,ab. 
46     (Systematic review not (trial or study)).ti. 
47     (nonrandom$ not random$).ti,ab. 
48     "Random field$".ti,ab. 
49     (random cluster adj3 sampl$).ti,ab. 
50     (review.ab. and review.pt.) not trial.ti. 
51     "we searched".ab. and (review.ti. or review.pt.)
52     "update review".ab. 
53     (databases adj4 searched).ab. 
54     (rat or rats or mouse or mice or swine or porcine or murine or sheep or lambs or pigs or piglets or rabbit or rabbits or cat or cats or dog or dogs or cattle or bovine or monkey or monkeys or trout or marmoset$1).ti. and animal experiment/ 
55     Animal experiment/ not (human experiment/ or human/) 
56     or/43‐55 
57     42 not 56
58     22 and 57 
59     limit 58 to yr="2019 ‐Current" 

PsycINFO Ovid

Searched 3 October 2017 [1339 records]
Searched 13 March 2019 [74 new records]
Searched 15 February 2021 [136 new records]

1 exp attention deficit disorder/
2 exp Behavior Problems/
3 adhd.tw.
4 addh.tw.
5 adhs.tw.
6 "ad/hd".tw.
7 TDAH.tw.
8 ((attention$ or behav$) adj3 (defic$ or dysfunc$ or disorder$)).tw.
9 ((disrupt$ adj3 disorder$) or (disrupt$ adj3 behav$) or (defian$ adj3 disorder$) or (defian$ adj3 behav$)).tw.
10 Impulsiveness/
11 (impulsiv$ or inattentiv$ or inattention$).tw.
12 hyperkinesis/
13 (hyperkin$ or hyper‐kin$ or hkd).tw.
14 (minimal adj3 brain$ adj3 (damag$ or disorder$ or dysfunc$)).tw.
15 (hyperactiv$ or hyper‐activ$).tw.
16 or/1‐15
17 methylphenidate/
18 (Adaphen$ or Aptensio$ or Aradix$ or Attenade$ or Biphentin$ or Calocain$ or Centedrin$ or Concerta$ or Conmet$ or Daytrana$ or Dexmethylphenidat$ or Difumenil$ or D‐methylphenidat$ or Equasym$ or Fenilidato$ or Focalin$ or Matoride$ or Medicebran$ or Medikid$ or Medikinet$ or Meridil$ or Metadate$ or Methylphenidylacetat$ or methyl phenidylacetat$ or Methylofenidan$ or Methylin$ or Methypatch or methylphenidat$ or Metilfenidato$ or Phenidylate or Phenidyl hydrochlorid$ or Phenidylhydrochlorid$ or Quillivant$ or Richter Works or Riphenidat$ or Ritalin$ or Ritrocel$ or Rubifen$ or Tsentedrin$).tw,id.
19 17 or 18
20 16 and 19
21 clinical trials/
22 random sampling/
23 placebo/
24 Experiment controls/ (836)
25 ((clinic$ or control$) adj (study or trial$ or experiment$)).tw.
26 ((compar$ or control$ or experiment$ or treat$) adj3 (subjects or group$)).tw.
27 ((singl$ or doubl$ or trebl$ or tripl$) adj3 (blind$ or mask$)).tw.
28 (randomiz$ or randomis$).tw.
29 randomly.tw.
30 exp program evaluation/
31 exp treatment outcomes/
32 exp treatment effectiveness evaluation/
33 ((effectiveness or evaluat$) adj3 (stud$ or research$)).tw.
34     or/21‐33
35 20 and 34
36 limit 35 to up=20190301‐20210208

Cochrane Database of Systematic Reviews (CDSR), in the Cochrane Library

Searched 3 October 2017 [10 records]
Searched 12 March 2019 [5 new records]
Searched 16 February 2021 [1 new record]

#1[mh "attention deficit and disruptive behavior disorders"]
#2[mh "attention deficit disorder with hyperactivity"]
#3(ADHD or ADHS or ADDH or AD next HD or HKD or TDAH):ti,ab,kw
#4((attention* or behav*) near/3 (defic* or dysfunc* or disorder*)):ti,ab,kw
#5(impulsiv* or inattentiv* or inattention*):ti,ab,kw
#6(hyperactiv* or hyper next activ*):ti,ab,kw
#7{or #1‐#6}
#8[mh methylphenidate]
#9(Adaphen* or Aptensio* or Aradix* or Attenade* or Biphentin* or Calocain* or Centedrin* or Concerta* or Conmet* or Daytrana* or Dexmethylphenidat* or Difumenil* or D‐methylphenidat* or Equasym* or Fenilidato* or Focalin* or Matoride* or Medicebran* or Medikid* or Medikinet* or Meridil* or Metadate* or Methylphenidylacetat* or methyl next phenidylacetat* or Methylofenidan* or Methylin* or Methypatch or methylphenidat* or Metilfenidato* or Phenidylate or Phenidyl hydrochlorid* or Phenidylhydrochlorid* or Quillivant* or Richter Works or Riphenidat* or Ritalin* or Ritrocel* or Rubifen* or Tsentedrin*):ti,ab,kw
#10#8 or #9
#11#7 and #10 in Cochrane Reviews, Cochrane Protocols
#12#7 AND #10 with Cochrane Library publication date Between Nov 2017 and Mar 2019, in Cochrane Reviews, Cochrane Protocols    
#13 #7 AND #10 with Cochrane Library publication date Between Mar 2019 and Feb 2021, in Cochrane Reviews, Cochrane Protocols

Database of Abstracts of Reviews of Effects (DARE), in the Cochrane Library

Searched 3 October 2017 [23 records]
Not searched after 2017 as database no longer maintained.

#1[mh "attention deficit and disruptive behavior disorders"]
#2[mh "attention deficit disorder with hyperactivity"]
#3[mh "conduct disorder"]
#4ADHD or ADHS or ADDH or "AD next HD" or HKD or TDAH
#5((attention* or behav*) near/3 (defic* or dysfunc* or disorder*))
#6((disrupt* near/3 disorder*) or (disrupt* near/3 behav*) or (defian* near/3 disorder*) or (defian* near/3 behav*))
#7(impulsiv* or inattentiv* or inattention*)
#8[mh hyperkinesis]
#9(hyperkin* or hyper‐kin* or hkd)
#10(minimal near/3 brain near/3 (disorder* or dysfunct* or damage*))
#11(hyperactiv* or hyper‐activ*)
#12{or #1‐#11}
#13[mh methylphenidate]
#14(Adaphen* or Aptensio* or Aradix* or Attenade* or Biphentin* or Calocain* or Centedrin* or Concerta* or Conmet* or Daytrana* or Dexmethylphenidat* or Difumenil* or D‐methylphenidat* or Equasym* or Fenilidato* or Focalin* or Matoride* or Medicebran* or Medikid* or Medikinet* or Meridil* or Metadate* or Methylphenidylacetat* or methyl phenidylacetat* or Methylofenidan* or Methylin* or Methypatch or methylphenidat* or Metilfenidato* or Phenidylate or Phenidyl hydrochlorid* or Phenidylhydrochlorid* or Quillivant* or Ritcher Works or Riphenidat* or Ritalin* or Ritrocel* or Rubifen* or Tsentedrin*)
#15#13 or #14
#16#12 and #15 in Other Reviews

CINAHL Plus EBSCOhost

Searched 4 October 2017 [634 records]
Searched 15 March 2019 [119 new records]
Searched 16 February 2021 [98 new records]

S1(MH "Attention Deficit Hyperactivity Disorder")
S2ADHD
S3ADDH
S4ADDH
S5ADHS
S6"AD/HD" or HKD OR TDAH
S7((attention* or behav*) n3 (defic* or dysfunc* or disorder*))
S8((disrupt* N3 disorder*) or (disrupt* N3 behav*) or (defian* N3 disorder*) or (defian* N3 behav*))
S9(impulsiv* or inattentiv* or inattention*
S10(MH "Hyperkinesis")
S11hyperkin* or hyper‐kin*)
S12(minimal N3 brain N3 (disorder* or dysfunct* or damage*))
S13hyperactiv* or hyper‐activ*
S14S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13
S15(MH "Methylphenidate")
S16(Adaphen* or Aptensio* or Aradix* or Attenade* or Biphentin* or Calocain* or Centedrin* or Concerta* or Conmet* or Daytrana* or Dexmethylphenidat* or Difumenil* or D‐methylphenidat* or Equasym* or Fenilidato* or Focalin* or Matoride* or Medicebran* or Medikid* or Medikinet* or Meridil* or Metadate* or Methylphenidylacetat* or methyl phenidylacetat* or Methylofenidan* or Methylin* or Methypatch or methylphenidat* or Metilfenidato* or Phenidylate or Phenidyl hydrochlorid* or Phenidylhydrochlorid* or Quillivant* or Richter Works or Riphenidat* or Ritalin* or Ritrocel* or Rubifen* or Tsentedrin*)
S17S15 OR S16
S18S14 AND S17
S19(MH "Clinical Trials+")
S20MH random assignment
S21(MH "Meta Analysis")
S22(MH "Crossover Design")
S23(MH "Quantitative Studies")
S24PT randomized controlled trial
S25PT Clinical trial
S26(clinical trial*) or (control* N2 trial*)
S27("follow‐up study" or "follow‐up research")
S28(prospectiv* study or prospectiv* research)
S29(MH "Program Evaluation")
S30(MH "Treatment Outcomes")
S31TI(single N2 mask* or single N2 blind*) OR AB(single N2 mask* or single N2 blind*)S32TI((doubl* N2 mask*) or(doubl* N2 blind*)) OR AB((doubl* N2 mask*) or (doubl* N2 blind*))
S33TI ((tripl* N2 mask*) or (tripl* N2 blind*)) or ((trebl* N2 mask*) or (trebl* N2 blind*)) OR AB((tripl* N2 mask*) or (tripl* N2 blind*)) or ((trebl* N2 mask*) or (trebl* N2 blind*)
S34(MH "Evaluation Research+")
S35TI (evaluat* N2 study or evaluat* N2 research) OR AB (evaluat* N2 study or evaluat* N2 research)
S36TI(random* OR RCT) OR AB(random* OR RCT)
S37S19 OR S20 OR S21 OR S22 OR S23 OR S24 OR S25 OR S26 OR S27 OR S28 OR S29 OR S30 OR S31 OR S32 OR S33 OR S34 OR S35 OR S36
S38S18 AND 37

Conference Proceedings Citation Index ‐ Science Web of Science Clarivate

Searched 4 October 2017 [166 records]
Searched 15 March 2019 [5 new records]
Searched 16 February 2021 [4 new records]

# 10 #9 AND #8
Indexes=CPCI‐S Timespan=All years
# 9 TS=(random* OR control* OR RCT* OR placebo* OR blind* or "systematic review" OR "meta analys*s")
Indexes=CPCI‐S Timespan=All years
# 8 #7 AND #6
Indexes=CPCI‐S Timespan=All years
# 7 TS= (Adaphen* or Aptensio* or Aradix* or Attenade* or Biphentin* or Calocain* or Centedrin* or Concerta* or Conmet* or Daytrana* or Dexmethylphenidat* or Difumenil* or "D‐methylphenidat*" or Equasym* or Fenilidato* or Focalin* or Matoride* or Medicebran* or Medikid* or Medikinet* or Meridil* or Metadate* or Methylphenidylacetat* or "methyl phenidylacetat*" or Methylofenidan* or Methylin* or Methypatch or methylphenidat* or Metilfenidato* or Phenidylate or "Phenidyl hydrochlorid*" or Phenidylhydrochlorid* or Quillivant* or "Richter Works" or Riphenidat* or Ritalin* or Ritrocel* or Rubifen* or Tsentedrin*)
Indexes=CPCI‐S Timespan=All years
# 6#5 OR #4 OR #3 OR #2 OR #1
Indexes=CPCI‐S Timespan=All years
# 5 TS=(minimal near/3 brain near/3 (disorder* or dysfunct* or damage*))
Indexes=CPCI‐S Timespan=All years
# 4 TS=(impulsiv* or inattentiv* or inattention* OR hyperkin* or "hyper‐kin*" OR hyperactiv* OR "hyper‐activ*")
Indexes=CPCI‐S Timespan=All years
# 3 TS=((disrupt* near/3 disorder*) or (disrupt* near/3 behav*) or (defian* near/3 disorder*) or (defian* near/3 behav*))
Indexes=CPCI‐S Timespan=All years
# 2 TS=((attention* or behav*) near/3 (defic* or dysfunc* or disorder*))
Indexes=CPCI‐S Timespan=All years
# 1 TS=(ADHD or ADHS or ADDH or "AD HD" or HKD or TDAH)
Indexes=CPCI‐S Timespan=All years

LILACS (Latin American and Caribbean Health Science Information)

Searched 4 October 2017 [19 records]
Searched 15 March 2019 [no new records]
Searched 16 February 2021 [no new records]

(mh:("attention deficit and disruptive behavior disorders" OR "attention deficit disorder with hyperactivity" OR "conduct disorder" OR hyperkinesis)) OR (tw:(adhd OR adhs OR addh OR "AD/HD" OR hkd OR tdah )) OR (tw:("ATTENTION DEFICIT*" OR impulsiv* OR inattentiv* OR inattention* OR hyperactiv* OR hyper‐activ*)) AND (mh:((adaphen* OR aptensio* OR aradix* OR attenade* OR biphentin* OR calocain* OR centedrin* OR concerta* OR conmet* OR daytrana* OR dexmethylphenidat* OR difumenil* OR d‐methylphenidat* OR equasym* OR fenilidato* OR focalin* OR matoride* OR medicebran* OR medikid* OR medikinet* OR meridil* OR metadate* OR methylphenidylacetat* OR methyl phenidylacetat* OR methylofenidan* OR methylin* OR methypatch OR methylphenidat* OR metilfenidato* OR phenidylate OR phenidylhydrochlorid* OR phenidylhydrochlorid* OR quillivant* OR richter works OR riphenidat* OR ritalin* OR ritrocel* OR rubifen* OR tsentedrin*))) AND (instance:"regional") AND ( db:("LILACS") AND type_of_study:("clinical_trials" OR "systematic_reviews"))

ClinicalTrials.gov clinicaltrials.gov/

Searched 4 October 2017 [48]
Searched 15 March 2019 Limited by First posted from 10/05/2017 to 03/15/2019 [4 new records]
Searched 16 February 2021 Limited by First posted from 03/15/2019  to 02/16/2021[22 new records]

LONG ACTING OR DELAYED OR EXTENDED OR PROLONGED OR RELEASE | ADHD OR "ATTENTION DEFICIT" OR HYPERACTIVE | Methylphenidate | Adult

EU Clinical Trials Register www.clinicaltrialsregister.eu/ctr‐search/

Searched 4 October 2017 [28 records]
Searched 15 March 2019 [2 new records]
Searched 16 February 2021 [1 new record]

methylphenidate AND ADHD AND Age Range = ADULT

ISRCTN www.isrctn.com/

Searched 4 October [5 records]
Searched 15 March 2019 [ no new records]
Searched 16 February 2021 [ no new records]

Condition: Attention Deficit Hyperactivity Disorder Interventions: methylphenidate Participant age range: Adult

WHO ICTRP www.who.int/ictrp/en/

Searched 4 October [38 records]
Searched 15 MARCH 2019 limited by date of registration between 05/10/2017 AND 15/03/2019 [5 new records] 
Attempted access 16 March 2021 limited by date of registration between 15/03/2019 AND 16/02/2021 but website unresponsive because of heavy traffic generated by pandemic.

CONDITION ADHD OR "ATTENTION DEFICIT" OR HYPERACTIV*

INTERVENTION methylphenidate AND extended OR methylphenidate AND prolonged OR methylphenidate AND release OR methylphenidate AND Long

Appendix 2. Search strategy (regulatory and pharmaceutical company databases)

Drug regulatory agencies

We included drug regulatory documents that contained data from clinical trials according to our inclusion criteria (Criteria for considering studies for this review). We did not include regulatory documents related to generic drugs or applications that did not include clinical trial data or only reported pharmacokinetic studies or studies in healthy adults.

We searched 12 drug regulatory agency databases (eTable 1). The European Medicines Agency has not approved any methylphenidate formulation, so we also searched the Heads of Medicines Agencies' (HMA) MR Index of approved drugs to identify which National Competent Authorities have approved the drugs in Europe. HMA’s MR Index is a European database of approved pharmaceutical drugs in the European Union across the different National Competent Authorities. The HMA MR Index database is not exhaustive, so we also handsearched all known European drug regulatory agencies' websites and databases of regulatory documents. See overview in eTable 1.

We describe each search string and detailed results in the Excel datafile available from osf.io/39wzk/?view_only=a1d2c58b069c4e99b8c836107e99fcad.

eTable 1. Overview of searched drug regulatory agency databases and websites

Regulatory agency (country)

Database

Content

Link

FDA (USA)

Drugs@FDA

Drug Approval Packages

www.accessdata.fda.gov/scripts/cder/daf

EMA (EU)

EMA Medicines

Public Assessment Reports

www.ema.europa.eu/en/medicines

Heads of Medicines Agencies (EU)

MR Index

Overview of approved drugs in the EU and links to various regulatory documents

mri.cts-mrp.eu/Human

Health Canada

Public Release of Clinical Information (PRCI)

Clinical Study Reports

clinical-information.canada.ca/search/ci-rc

Health Canada

Drug Product Database

Product Monographs

www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/drug-product-database.html

Health Canada

Drug and Health product Register

Summary Basis of Decision Letters

hpr-rps.hres.ca/reg-content/summary-basis-decision.php

TGA (AU)

Australian Register of Therapeutic Goods

Prescribing Information

www.tga.gov.au/artg

TGA (AU)

AusPAR database

Public Assessment Reports

www.tga.gov.au/ws-auspar-index

BfArM (DE)

Pharmnet‐Bund

Public Assessment Reports, CSR synopses

PharmNet.bund.de

MEB (NL)

The Medicines Data Bank

Public Assessment Reports, CSR synopses

www.geneesmiddeleninformatiebank.nl/en

MHRA (UK)

Products database

SmPC, Public Assessment Reports

products.mhra.gov.uk

ANSM (FR)

Rapports publics d'évaluation

Public Assessment Reports

archiveansm.integra.fr/Mediatheque/Publications/Rapports-Syntheses-Rapports-publics-d-evaluation

HPRA (IE)

Find a medicine

Public Assessment Reports, SmPC, PIL

www.hpra.ie/homepage/medicines/medicines-information/find-a-medicine

SwissMedic

SwissPAR database

Public Assessment Reports

www.swissmedic.ch/swissmedic/de/home/humanarzneimittel/authorisations/swisspar.html

PMDA (JN)

Review Reports database

Public Assessment Reports

www.pmda.go.jp/english/review-services/reviews/approved-information/drugs/0001.html

ANSM: Agence Nationale de Sécurité du Médicament et des Produits de Santé; AU: Australia; BfArM: Bundesinstitut für Arzneimittel und Medizinproducte [

Federal Institute for Drugs and Medical Devices]; DE: Deutschland (Germany); EMA: European Medicines Agency; FDA: US Food and Drug Administration; FR: France; HPRA: Health Products Regulatory Authority; IE: Ireland; JN: Japan; MEB: Medicines Evaluation Board; MHRA: Medicines and Healthcare products Regulatory Agency; NL: Netherlands; PIL: Patient Information Leaflet; PMDA: Pharmaceuticals and Medical Devices Agency; SmPC: Summary of Product Characteristics; TGA: Therapeutic Goods Administration; UK: United Kingdom.

Pharmaceutical company databases

We searched the websites and clinical trial databases of the marketing authorisation holders of extended‐release methylphenidate formulations approved for use in adults: Novartis (Ritalin LA, Ritalin SR and Focalin XL), Janssen (Concerta), Medice (Medikinet) and Purdue (Foquest/Adhansia).

Yale University Open Data Access (YODA)

The YODA database (yoda.yale.edu) contains clinical trial results from Johnson & Johnson sponsored trials, which Janssen is a part of. We assessed trials with the tag 'methylphenidate'. You may also request full clinical study reports from the YODA database. We did not do this for the current version of review but it might be relevant for potential review updates.

Novartis

Clinical Trial Results Database, available at www.novctrd.com. We used the keyword 'ADHD'.

Medice

We searched Medice’s website, www.medice.de/the-company, but they do not seem to have a publicly available database of clinical trial data. We contacted the company’s medical director but our request to access the data was declined, see also Potential biases in the review process.

Purdue

Purdue has a website dedicated to sharing clinical trial results, www.purduepharma.com/healthcare-professionals/clinical-trials. The data are not publicly available and you have to file a formal request to get access. We decided not to request access to data for this version of the review. They might be relevant for a future update.

Appendix 3. Results from trial registries, company databases and other resources

eTable 2. ClinicalTrials.gov

NCT ID

Related trial

Data available

Document type

NCT00061087a

Levin 1998a

No

N/A

NCT00136734a

Levin 1998b

No

N/A

NCT00181571a

Biederman 2003

No

N/A

NCT00318981a

Chronis‐Tuscano 2004

No

N/A

NCT00619840

Rösler 2004

No

N/A

NCT00261872

Combine Substudy 2005

No

N/A

NCT00246220

Medori 2005

Yes

Clinical study report synopsis (German extension study)a,b

NCT00253747

Winhusen 2005

Yes

Data on website

NCT00326391

Adler 2006

Yes

Clinical study report synopsisa

NCT00482313

Ginsberg 2007

No

N/A

NCT00714688

Casas 2008

Yes

Data on website

NCT00730249

Retz 2008

No

N/A

NCT00931398

College Study 2009

No

N/A

NCT00937040

Goodman 2009

Yes

Data on website

NCT00880217a

Weisler 2009

No

N/A

NCT01259492

Huss 2010

Yes

Data on website

NCT01323192a

Takahashi 2011

Yes

Data on website

NCT02139124a

Weiss 2014

Yes

Data on website

NCT03481959a

Methacan 2017

No

N/A

CSR: Clinical Study Report; EUCTR: EU Clinical Trials Register; ID: identifier; NCT: National Clinical Trial; N/A: not applicable; YODA: Yale University Open Data Access.

Footnotes
aIdentified via cross‐referencing.
bThe synopsis is about a German extension phase of the study.
 

eTable 3. EU Clinical Trials Register

Identifier

Related trial

Data available

Document type

2004­000730­37

Medori 2005

Yes

Clinical Study Report synopsis

2006‐000222‐31a

Compas 2007 CMCompas 2007 GPT

No

N/A

2006‐002249‐35

Konstenius 2007

No

N/A

2006‐002553‐80a

Ginsberg 2007

No

N/A

2007‐002111‐82

Casas 2008

Yes

Document not includedb

2008‐000942‐29a

Retz 2008

Yes

Document not includedc

2010‐021533‐31

Huss 2010

Yes

Clinical trial report (53 pages)

2015‐004271‐78

Asherson 2016

Yes

Clinical Study Report

2017‐000386‐77

Methacan 2017

No

N/A

EUCTR: EU Clinical Trials Register; N/A: not applicable; YODA: Yale University Open Data Access.

Foonotes

aIdentified via cross‐referencing.
bPDF‐file of data from ClinicalTrials.gov.
cEarlier version of the included synopsis from BfArM.
 

eTable 4. ISRCTN

Identifier

Related trial

Data available

Document type

ISRCTN81602628

Konstenius 2006

No

N/A

ISRCTN54096201

Compas 2007 CM/Compas 2007 GPT

No

N/A

ISRCTN77940178

Konstenius 2007

No

N/A

ISRCTN16827947a

Asherson 2016

No

N/A

N/A: not applicable

Footnote

aIdentified via cross referencing.

eTable 5. Pharmaceutical company databases

Database

Identifier

Trial

Available data

Novartis

CRIT124E2302

Spencer 2003a

Clinical study report synopsis

Novartis

CRIT124D2302

Huss 2010

Document not includeda

Novartis

CRIT124D2302E1

Huss 2010

Document not includedb

YODAc

NCT00246220

Medori 2005

Document not includeda

YODA

NCT00326391

Adler 2006

Clinical study report synopsisd

YODA

NCT00714688

Casas 2008

Clinical study report synopsis

YODA

NCT00937040

Goodman 2009

Clinical study report synopsisd

YODA

NCT01323192

Takahashi 2011

Clinical study report synopsisd

NCT: National Clinical Trial; YODA: Yale University Open Data Access.

Footnotes

For YODA, we counted the trial entries and available documents as separate records in our flowchart. For Novartis, we only counted the included documents in our flowchart.

aIdentical to document from EU Clinical Trials Register, therefore not included.
bSimilar to the document from BfArM (but without the amendments), therefore not included.
cThe Yale University Open Data Access (YODA) declined two of our requests. The Weisler 2009 trial was sponsored by Janssen and compared bavisant, a histamine antagonist, with placebo, OROS methylphenidate and atomoxetine. Our request was declined because bavisant has been out‐licensed to another company. Chronis‐Tuscano 2004 lists McNeil as sponsor in the published report, and as collaborator and sponsor in the Clinicaltrials.Gov entry. We were not granted access to data with the argument that Johnson & Johnson is not the data holder.
dMade available upon our request.

eTable 6. National guidelines and other systematic reviews

One author (KB) handsearched two national guidelines (Sundhedsstyrelsen 2017NICE 2018), as prespecified in our protocol (Boesen 2017b), and the two most recently published systematic reviews (Cortese 2018Elliott 2020). It yielded three additional records, and three references were not obtainable.

Sundhedsstyrelsens Nationale Kliniske Retningsline (2017)

We assessed the file ‘PICO 3 – MPH versus placebo’. Exact references to publications were not reported in the file (available from www.sst.dk/-/media/Udgivelser/2015/NKR-ADHD-voksne/PICO-3---MPH-vs,-d-,-placebo-PDF.ashx?la=da&hash=844986F014AF8E03BA2845BBF62FDEB42CC15FD9):

Carpentier (not included, cross‐over)
Gualtieri 1985 (not included, immediate‐release (IR) methylphenidate (MPH))
Spencer 1995 (not included, IR MPH)
Kuperman 2001 (not included, IR MPH)
Schubiner 2002 (not included, IR MPH)
Tennenbaum 2002 (not included, cross‐over)
Bouffard 2003 (not included, cross‐over)
Kooij 2004 (not included, cross‐over)
Spencer 2005 (not included, cross‐over)
Biederman 2006 (already included)
Levin 2006 (already included)
Jain 2007 (not included, cross‐over)
Levin 2007 (already included)
Reimherr 2007 (not included, cross‐over)
Spencer 2007 (already included)
Medori 2008 (already included)
Adler 2009 (already included)
Rösler 2009 (already included)
Biederman 2010 (already included)
Konstenius 2010 (already included)
Rösler 2010 (already included)
Winhusen 2010 (already included)
Ginsberg 2012 (already included)
Ginsberg 2012a (already included)
Retz 2012 (already included)
Weisler 2012 (already included)
Casas 2013 (already included)
Konstenius 2013 (already included)
Rösler 2013 (already included, Medori 2005 publication)
Huss 2014 (already included)

We identified no additional references.

NICE guideline (2018)

We assessed the ‘Evidence Review’, appendix D, on ‘Pharmacological efficacy and sequencing’. On page 39, the list of randomised controlled trials (RCTs) in adults appear (section 1.1.3.5), of which 12 used extended release methylphenidate. Available from www.nice.org.uk/guidance/ng87/evidence/c-pharmacological-efficacy-and-sequencing-pdf-4783686303.

Ref 21: Adler et al 2009, Journal of Clinical Psychopharmacology (already included)
Ref 90: Biederman et al 2006, Biological Psychiatry (already included)
Ref 91: Biederman et al 2010, Journal of Clinical Psychopharmacology (already included)
Ref 117: Bron et al 2014, Neuropsychopharmacology (not included; cross‐over)
Ref 140: Casas et al 2013, World Journal of Biological Psychiatry (already included)
Ref 162: Chronis‐Tuscano et al 2008, Journal of Clinical Psychiatry (already included)
Ref 282: Ginsberg et al 2012, British Journal of Psychiatry (already included)
Ref 287: Goodman et al 2017, Journal of Clinical Psychiatry (already included)
Ref 446: Medori et al 2008, Biological Psychiatry (already included)
Ref 524: Retz et al 2012, World Journal of Biological Psychiatry (already included)
Ref 533: Rosler et al 2009, European Archives of Psychiatry and Clinical Neuroscience (already included)
Ref 594: Spencer et al 2007, Biological Psychiatry (already included) (on page 32, it mistakenly says ref 593 which is an IR‐MPH trial).

We identified no additional references.

Cortese systematic review (2018)

Fifty‐one studies with adult ADHD were included (Cortese 2018). We handsearched all 133 included studies listed in the Supplement, Appendix 8, ‘Studies/citations retained for the network meta‐analysis’ (page 237), because they were not categorised according to intervention. Studies that seemed relevant (adult ADHD; extended‐release methylphenidate) or studies we were unable to exclude solely based on the information provided in Supplement appear here.

Ref 6: Adler 2009 (already included, we did not include the Adler 2011 publication since this is an open label extension, which is listed in our excluded list)
Ref 15: Bedard 2015 (not included; children and adolescents)
Ref 18: Biederman 2006 (already included, all references)
Ref 23: Biel 2016 (not included, immediate release (IR))
Ref 25: Bron 2014 (not included, cross‐over study)
Ref 27: Casas 2013 (already included, all references)
Ref 32: CRIT124 (information not provided in list; study with adolescents, not included)
Ref 45: Ginsberg study (already included, all references)
Ref 46: Goodman study (already included, all references)
Ref 55: Huss study (already included, all references)
Ref 63: Kooij 2004 (not included, cross‐over)
Ref 70: Medori 2008 (already included, three references included, two not obtainable)
Ref 77: NCT01069523 (not included, children)
Ref 82: COMPAS study (already included, all references)
Ref 85: Reimherr 2007 (not included, cross‐over)
Ref 86: Rösler 2009 (already included, all references)
Ref 92: Schrantee (not included, IR methylphenidate)
Ref 98: Spencer 1995 (not included, IR methylphenidate)
Ref 103: Spencer 2005 (not included, IR methylphenidate)
Ref 105: Spencer 2003 (already included, one reference not obtainable)
Ref 112: Takahashi 2012 (already included, all references)
Ref 120: Weisler 2012 (already included, all references)
Ref 122: Wender 2011 (not included, IR methylphenidate)
Ref 132: Winhusen (already included, all references)

We identified six additional references (three included, three unobtainable).

Elliot systematic review (2020)

We assessed the studies listed in Elliott 2020, table 1. Studies with relevant interventions (MPH, MPH SR, MPH LA, and OROS MPH) and a parallel group design are listed here.

Matochik 1994 (not included, formulation not specified but we assume it was immediate release (IR))
Levin 2001 (already included, all references)
Biederman 2006 (already included, all references)
Levin 2006 (already included, all references)
Levin 2007 (already included, all references)
Spencer 2007 (already included, all references)
Medori 2008 (already included, all references)
Adler 2009 (already included, all references)
Rösler 2009 (already included, all references)
Biederman 2010 (already included, all references)
Konstenius 2010 (already included, all references)
Philipsen 2010 (already included, all references)
Winhusen 2010 (already included, all references)
Ginsberg 2012 (already included, all references)
Retz 2012 (already included, all references)
Weisler 2012 (already included, all references)
Casas 2013 (already included, all references)
Huss 2014 (already included, all references)
Konstenius 2014 (already included, all references)
Takahashi 2014 (already included, all references)
Schrantee 2016 (not included, IR)
Goodman 2017 (already included, all references)

We identified no additional references.

eTable 7. Cross referenced records

Type of record

Records

Related trial(s)

Publications

11

Levin 1998a (1), Compas 2007 CM/Compas 2007 GPT (2), Ginsberg 2007 (1), Huss 2010 (4), Medori 2005 (3)

ClinicalTrials.gova

10

Levin 1998a entry; Levin 1998b entry; Biederman 2003 entry; Chronis‐Tuscano 2004 entry; Medori 2005 CSR synopsisbAdler 2006 CSR Synopsis; Weisler 2009 entry; Takahashi 2011 entry; Weiss 2014 entry; Methacan 2017 entry

EU Clinical Trials Registera

6

Medori 2005 CSR synopsis; Compas 2007 CM/Compas 2007 CM entry, Ginsberg 2007 entry, Retz 2008 entry, Huss 2010 Clinical Trial Report; Asherson 2016 Synopsis

ISRCTNa

1

Asherson 2016 entry

NiH RePORTERa

2

Levin 1998a (1), Levin 1998b (1)

Total records

30

 

 Footnotes

CSR = Clinical Study Report; NiH = National Institute of Health Research Portfolio Online Reporting Tools

aTrial entries or separately linked documents.
bGerman extension study.

Appendix 4. Results from drug regulatory agencies

Drug regulatory databases

See the full search results in the additional datafile available on OSF (osf.io/39wzk/?view_only=a1d2c58b069c4e99b8c836107e99fcad).

eTable 8. Drug regulatory documents

Agency

Documenttype

Drug (trade name)

Related trial(s)

BfArM

Public Assessment Report (English)

Extended‐release methylphenidate

(Medikinet®)

Rösler 2004 and Retz 2008

BfArM

Public Assessment Report (German)

Extended‐release methylphenidate (Medikinet®)

Rösler 2004 and Retz 2008

BfArM

CSR synopsisc

Extended‐release methylphenidate

(Medikinet®)

Retz 2008

BfArM

CSR synopsis

OROS methylphenidate

(Concerta®)

Medori 2005

BfArM

Clinical Trial Report

ER methylphenidate

(Medikinet®)

Compas 2007 CM/Compas 2007 GPT

BfArM

CSR synopsis

OROS methylphenidate

(Concerta®)

 

Casas 2008

BfArM

CSR synopsis + (part of) Clinical Trial Reporte

LA methylphenidate

(Ritalin LA®)

Huss 2010

BfArM

Clinical trial report (extension study)

LA methylphenidate

(Ritalin LA®)

Huss 2010

FDA

Drug Approval Package

OROS methylphenidate

(Concerta®)

Medori 2005 and Adler 2006

FDA

Drug Approval Package

Controlled‐release methylphenidate

(Adhansia®)

Weiss 2014

FDA

Drug Approval Package

Dex‐methylphenidate

(Focalin XR®)

Spencer 2003a

Health Canada

Product Monograph

Controlled‐release methylphenidate

(Foquest®)

Weiss 2014

 

Health Canada

Product Monograph

OROS methylphenidate

(Concerta®)

Medori 2005

MEB

Public Assessment report

Long‐acting methylphenidate

(Ritalin LA/XL®)

 

Huss 2010

MHRA

Public Assessment Report

Long‐acting methylphenidate

(Ritalin XL®)

Huss 2010

MHRA

Public Assessment Report

OROS methylphenidate

(Concerta®)

Medori 2005Adler 2006 and Casas 2008

 

TGA

Prescribing Information

Extended‐release methylphenidate

(Ritalin LA®)

Huss 2010

TGA

Prescribing Information

OROS methylphenidate

(Concerta®)

Medori 2005Adler 2006, and Casas 2008b

BfArM: Bundesinstitut für Arzneimittel und Medizinprodukte [Federal Institute for Drugs and Medical Devices]; CSR: Clinical Study Report; ER: extended release; FDA: US Food and Drug Adminsitration; ID: identifier; LA: long acting; MEB: Medicines Evaluation Board; MHRA: Medicines and Healthcare products Regulatory Agency; MPH: methylphenidate; OROS: Osmotic controlled‐Release Oral delivery System ; TGA: Therapeutic Goods Administration; XL: prolonged release

Footnotes:
aThis was a BfArM Public Assessment Report of Medikinet in German. We did not find this record in our systematic search of the BfArM database, but as a reference in an Arzneitelegramm (www.arznei-telegramm.de/html/2011_10/1110085_01.html).
bOnly harms data from Casas 2008 were included.
cAlmost identical to document from EUCTR.
eOne collated document, consisting of one CSR Synopsis and a part Clinical Trial Report (the full report was found on EUCTR).

Appendix 5. Author correspondence

We contacted all corresponding authors. Seven of the correspondences were fruitful; three correspondences yielded additional information, and four correspondences yielded a total of nine additional records for inclusion in the review.

eTable 9. Overview of author correspondence

Trial

Corresponding author

Sponsorship

Outcome and summary of correspondence

Levin 1998a and Levin 1998b

Frances Levin

Publicly funded

Negative. No reply after three emails.

Levin 2001

Edward Levin

Publicly funded

Negative. No reply after three emails.

Biederman 2003

Joseph Biederman

Janssen

Negative. Author reply: “Sorry. The sponsor has the data”.

Spencer 2003a

Thomas Spencer

Novartis

Negative. No reply after three emails.

Chronis‐Tuscano 2004

Andrea Chronis‐Tuscano

Publicly funded with industry‐involvement

Negative. No reply after three emails.

Rösler 2004

Michael Rösler

Medice

Negative. No reply after three emails.

Combine Substudy 2005

Raymond Anton

Publicly funded

Negative. Corresponding author referred us to the NIH database but informed us that there would be no data of interest. We contacted the NIH data manager about the content. We did not receive a reply after three emails.

Medori 2005

Rossella Medori

Janssen

Negative. No reply after three emails.

Winhusen 2005

Theresa Winhusen

Publicly funded with industry‐involvement

Positive. One record (trial protocol) and corresponding author also referred us to the trial database.

Adler 2006

Lenard Adler

Janssen

Negative. Author reply: “You need to contact the study sponsor”.

Konstenius 2006 and Konstenius 2007

Maija Konstenius

Publicly funded

Negative. Replied to our first email but did not respond to our follow‐up emails where we specified our request.

Compas 2007 CMCompas 2007 GPT

Alexandra Philipsen

Publicly funded with industry‐involvement

Positive. One record (documents describing adverse events and serious adverse events), and corresponding author also referred us to the BfArM website where the full trial report was available.

Ginsberg 2007

Ylva Ginsberg

Publicly funded

Positive. Two records (doctoral thesis, one published article).

Casas 2008

Miguel Casas

Janssen

Negative. Author reply: “We have not the raw data as it was a Janssen's study”.

Retz 2008

Wolfgang Retz

Medice

Negative. No reply after three emails.

College Study 2009

Oscar Bukstein

Publicly funded with industry‐involvement

Positive.

Auhor reply: “I apologize; the project funding was withdrawn before we got started. I forgot to take this off clinicaltrials.gov

Oscar Bukstein”

Our response: “Thank you indeed for the quick reply. Can you tell me why the funding was withdrawn, it seemed like a very important study?”

Author reply: “We thought so too. Investigator‐initiated pharma sponsored study. The bosses thought it was too close to end of patent.”

Goodman 2009

H Lynn Starr (medical director)

Janssen

Positive. We were contacted by Janssen's Therapeutic Area Head, who informed us to request data at YODA.

Weisler 2009

Ella Daly

Janssen

Positive. One record (conference proceeding) and referred to YODA database for further information.

Huss 2010

Michael Huss

Novartis

Negative. The author replied to our first email, but not to our second email in which we we specified the data we were interested in.

Author reply: “Thank you for contacting me on this behalf. However, I was a bit irritated since we did not have OROS‐methlyphenidate but MPH‐LA in our study”. In the email, we had by mistake written 'OROS MPH' and not 'MPH LA'.

Takahashi 2011

Nagahide Takahashi

Janssen

Negative. No reply after three emails.

Weiss 2014

Margaret Weiss

Purdue

Positive. Four records (conference posters), sent from Adlon Therapeutics.

Asherson 2016

Philip Asherson

Publicly funded

Negative. Replied to our first email but did not reply to subsequent emails where we asked for the protocol and potential interim data.

Methacan 2017

Elodie Soler

Publicly funded

Negative. No reply after three emails.

BfArM: Bundesinstitut für Arzneimittel und Medizinprodukte [Federal Institute for Drugs and Medical Devices]; LA: long acting; MPH: methylphenidate; NIH: National Institutes of Health; OROS: osmotic‐controlled release oral delivery system; YODA: Yale University Open Data Accesss.

Appendix 6. Serious adverse events

eTable 10. Specification of serious adverse events

Study

Methylphenidate

Placebo

Number of participants

Number of serious adverse events

Type of event(s) (number of events)

Number of participants

Number of serious adverse events

Type of event(s) (number of events)

Biederman 2003

109

0

None

114

0

None

Spencer 2003ab

165

2 events in 2 participants

Ulcerative colitis and hypovolemic shock, high fever and loss of consciousness

53

0

None

Medori 2005c

305

4 events in 4 participants

Cerebrovascular accident, anxiety disorder, migraine attack, depressive disorder

96

0

None

Winhusen 2005

127

2

Car accident, worsening of depression leading to hospitalisation

128

0

None

Adler 2006d

110

0

None

116

0

None

Compas 2007 CMCompas 2007 GPTe

205

19 events in 15 participants

Depression (1), suicidal ideation (1), aggression (1), tension (1), somnambulism (1), alcohol poisoning (1), appendix disorder (1), ocular hypertension (1), retinal detachment (1), cholecystectomy (1), rehabilitation therapy (1), adenomyosis (1), haermorrhagic ovarian cyst (1), transient ischaemic attack (1), pneumonia (1), pregnancy (2), chest pain (1), tachycardia (1).

209

12 events in 9 participants

Depression (1), suicidal ideation (1), road traffic accident (2), epicondylitis (1), fall (1), abdominal discomfort (1), gastrointestinal pain (1), ovarian cyst (1), syncope (1), salpingitis (1), vertigo (1), arthroscopy (1).

Ginsberg 2007

15

0

None

15

0

None

Konstenius 2007f

27

0

None

Not reported

Not reported

Not reported

Casas 2008g

181

7 events in 5 participants

Abdominal pain + nausea, ruptured ovarian cyst, suicidal ideation and subsequent suicide attempt, concussion, inter‐vertebral disc protrusion (1 each)

97

2 events in 2 participants

Cholecystitis (1), joint injury (1)

Retz 2008

84

1

Rupture of the acromioclavicular joint

78

2

Appendicitis, postoperative pain

Goodman 2009

174

0

None

175

1 event in 1 participant

Suicidal ideation

Weisler 2009 h

68

1

Convulsion

73

1

Pericarditis

Huss 2010i

542

4 events in 4 participants

Goiter, infected bites, loss of consciousness, ovarian cyst rupture

180

6 events in 2 participants

Sudden hearing loss and vertigo, eye infection, syncope, agitation and depression

Takahashi 2011

143

2

Psychotic disorder, tension pneumothorax

141

0

None

Weiss 2014j

297

16 events in 12 participants

Diarrhoea (1), feeling jittery (1), cellulitis (1), muscle strain (1), osteoarthritis (1), uterine cancer (1), headache (1), anxiety (1), emotional disorder (1), insomnia (3), mood altered (1), psychotic disorder (1), calculus urinary (1), nephrolithiasis (1).

78

2 events in 2 participants

Headache (2)

Footnotes

aThe 15 trials reporting serious adverse events for at least one group.
bReported in FDA (Food and Drug Administration) Medical Review, p 19. The three other events occurred in extension phase.
c'Aggression and delusion of reference' was not listed as a serious adverse event.
d'Abnormal thinking" was not listed as a serious adverse event.
eReported for the two methylphenidate and placebo groups together at 52 weeks follow‐up.
fReported in conference proceeding, but not for placebo group.
gData according to ClinicalTrials.gov.
hThe pericarditis event in the placebo group occurred after study completion, but it was not reported when exactly. In comparison, the aneurism event in Huss 2010 (see below), was not included since it occurred after study completion.
iWe noted that one death (in the methylphenidate group) due to aortic dissection rupture 21 days after study completion was not reported as a serious adverse event (Huss 2010; Huss et al. 2014, p 56).
jThere were important differences between reported serious adverse events in Health Canada’s Product Information, FDA’s Medical Review and on ClinicalTrials.gov. We used the ClinialTrials.gov results.

Appendix 7. Severe psychiatric adverse events

eTable 11. Serious adverse events or severe psychiatric adverse events

Study

Serious psychiatric adverse events and severe psychiatric adverse events

Methylphenidate (number of participants)

Placebo (number of participants)

Comments

Levin 1998a

Not reported

Not reported

Adverse effects were collected according to severity (mild/moderate/severe) (Levin 2006, p 145), but they were not reported in the paper.

Levin 1998b

Not reported

Not reported

Adverse effects were collected according to severity (mild/moderate/severe) (Levin 2007, p 26), but they were not reported in the paper.

Levin 2001

Not reported

Not reported

Biederman 2003

No SAEs. Severe adverse events not described

No SAEs. Severe adverse events not described

Spencer 2003a

No SAEs. Overall rate of "severe adverse events" of 8.5%; ('insomnia' was reported by 2 participants)

No SAEs. Rate of "severe adverse events" of 5.7%; events not specified for the placebo participants

Only "severe adverse events" occurring in more than one participant was reported (Spencer 2007, p 1384)

Chronis‐Tuscano 2004

Not reported

Not reported

Rösler 2004

Not reported

Not reported

Akathisia and dyskinesia were mentioned as "neurological abnormalities", but not detailed (Rösler 2009, p 125)

Medori 2005

2 SAEs: 'depression' and 'anxiety'. 3% of participants experienced psychosis/mania (combined Medori 2005Adler 2006Casas 2008); three of these events were highlighted as "severe" ('thinking abnormal', 'delusion of reference', 'abnormal behaviour) but uncertain whether this list was exhustive.

0 SAEs, "severe adverse events" not systematically reported. 1% of participants (combined Medori 2005Adler 2006Casas 2008) experienced placebo/mania, but not further specified.

Not reported systematically. The data was reported under "Psychosis/mania" in the MHRA Public Assessment Report (MHRA 2010, p 63)

Winhusen 2005

1 SAE ('worsening of depression'). Severe adverse events not described.

No SAEs. Severe adverse events not described.

Adler 2006

0 SAEs. "severe" adverse events included: 'abnormal thinking', 'irritability', 'anxiety', 'initial insomnia' and 'asthenia'. Frequency not reported.

0 SAEs. 2 "severe adverse events" included 'somnolence' and 'affect lability'. Frequency not reported.

A total of 8 participants experienced severe adverse events on methylphenidate, and 4 on placebo. Reported in Adler 2009, p 244.

Konstenius 2006

SAEs not reported. No severe adverse events.

SAEs not reported. No severe adverse events.

"Reported Aes were mild and reversible", (Konstenius 2010, p 132). We therefore assume that no severe events occurred.

Compas 2007 CMCompas 2007 GPT

5 SAEs: 'depression' (1), 'suicidal ideation' (1), 'aggression' (1),' tension' (1), 'somnambulism' (1). Severe adverse events not described

2 SAEs: 'depression' (1), 'suicidal ideation' (1). Severe adverse events not described

Reported in document sent by corresponding author (Philipsen 2020, personal communication)

Ginsberg 2007

No SAEs. Severe adverse events not described

No SAEs. Severe adverse events not described. 'Intrusive thoughts' (1) listed as event but severity not described

'Instrusive thoughts' [Tvångstanker] listed in adverse event table in Ginsberg & Lindefors, 2013 p. 24.

The severity of events were described as, "The severity of AEs was usually rated as mild to moderate and not a reason for discontinuation" (Ginsberg thesis 2012, p 53).

Konstenius 2007

No SAEs. Severe adverse events not described.

SAEs not reported. No reporting of severe adverse events. 'Hearing voices' (1) and 'agitation' listed as events, but severity not described.

Konstenius 2014, p 446

Casas 2008

2 SAEs in one participant: 1 'suicide ideation' and 1 'suicide attempt'. Severe adverse events not specified

No SAEs of interest. Severe adverse events not specified

The total number of participants experiencing a severe adverse event was reported in the YODA CSR synopsis on p. 23: 23 participants on MPH and 10 participants on placebo. Events not specified.

Retz 2008

No relevant SAEs. "No severe adverse events related to study medication".

No relevant SAEs. "No severe adverse events related to study medication".

Retz 2012, p 57.

Goodman 2009

0 SAEs. 3 participants with "severe adverse events": 'anxiety' (1), 'restlessness' (1), and 'nervousness and jitter' (1).

1 SAE: 'suicidal ideation'. 1 participant with severe adverse event: 'insomnia'.

Severe adverse events reported in Goodman 2017, p 111.

Weisler 2009

No SAEs. Severe adverse events not described. 'Suicidal ideation' (1) listed as event but not described further.

No SAEs. Severe adverse events not described. 'Suicidal ideation' (1) listed as event but not described further.

The suicidal events were captured using the Columbia Suicide Severity Rating Scale (Weisler 2012, p 430).

Huss 2010

0 SAEs. Severe adverse events not described

2 SAEs: 'depression' and 'agitation' (unclear if one or two participants). Severe adverse events not described

Takahashi 2011

1 SAE ('psychotic disorder'). 9 answered 'yes' to questions regarding suicidal ideations (6 according to the CSR synopsis). Severe adverse events not described.

0 SAEs. 9 participants answered 'yes' to having suicidal ideation (2.9%, corresponding to 4 participants). Severe adverse events not described.

The suicidal events were captured using the Columbia Suicide Severity Rating Scale (YODA CSR synopsis, p 16).

Weiss 2014

8 SAEs: 'Anxiety' (1), 'emotional disorder' (1), 'insomnia' (3), 'mood altered' (1), 'psychotic disorder' (1), 'feeling jittery' (1). Severe adverse events not described. Suicidal ideation (100mg group) (1).

0 SAEs. Severe adverse events not described. Suicidal behaviour (1).

Data comes from the ClinicalTrial.gov entry. Note that in FDA's Clinical Review, the SAEs are called "significant adverse events" (FDA Clinical Review, p. 35 of 57). The suicide events are described in Weiss 2020, p 7.

CSR: Clinical Study Report.FDA: US Food and Drug Administration. MHRA: Medicines and Healthcare product Regulatory Agency. P: Page. SAE: Serious adverse events. YODA: Yale Open access DAtabase.

 

eTable 12. Dose reductions due to psychiatric adverse events

Study

Dose reductions due to psychiatric adverse events

Methylphenidate (number of participants)

Placebo (number of participants)

Comments

Levin 1998a

3 participants, but the adverse events were not reported

0

Reasons for dose reduction were not described

Levin 1998b

3 participants ('insomnia', 'depressed', and 'clenched jaws')

1 participant ('sedation')

Levin 2001

Fixed dose

Fixed dose

Biederman 2003

Not reported

Not reported

Spencer 2003a

Fixed dose

Fixed dose

Chronis‐Tuscano 2004

Not reported

Not reported

Rösler 2004

Not reported

Not reported

Medori 2005

Fixed dose

Fixed dose

Winhusen 2005

Not reported

Not reported

Adler 2006

3 participants experienced 'anxiety'

Not reported

Only events leading to dose reduction in 2% of participants or more were reported. Adler 2009, p 244.

Konstenius 2006

Not reported

Not reported

'Nervousness' (1), but not described if it occurred in the methylphenidate or placebo arm.

Compas 2007 CMCompas 2007 GPT

Not reported

Not reported

Ginsberg 2007

Fixed dose

Fixed dose

Konstenius 2007

'Feeling edgy' (1)

'Suicidal ideation' (1)

The event in the placebo group led to "study medication discontinuation".

Casas 2008

Fixed dose

Fixed dose

Retz 2008

19 total dose reductions. Reasons for reduction not described.

2 total dose reductions. Reasons for reduction not described.

Retz 2012, p 53

Goodman 2009

Not reported

Not reported

Weisler 2009

Dose reduction was not allowed

Dose reduction was not allowed

Huss 2010

Fixed dose

Fixed dose

Takahashi 2011

Not reported

Not reported

Weiss 2014

Fixed dose

Fixed dose

P: Page.

eTable 13. Dropouts due to psychiatric adverse events

Study

Dropouts (due to psychiatric adverse events)

Methylphenidate (number of participants)

Placebo (number of participants)

Comments

Levin 1998a

'Psychomotor agitation' (1)

No dropouts

We did not count the 'fatigue' event in the placebo group as a psychiatric event.

Levin 1998b

'Persistent insomnia' (1) and 2 participants were "removed from the protocol because of worsening of pre‐existing mood lability [and] anxiety".

3 participants were "removed from the protocol because of worsening of pre‐existing depression".

it is unclear what the 'removal from the protocol' entails (Levin 2007, p 22 (3.1. 'participant flow'). In the flowchart, respectively 3 participant on methylphenidate and 2 on placebo were listed as dropout due to "psychiatric", but events not described further.

Levin 2001

Not reported

Not reported

None

Biederman 2003

6 AEs leading to drop out: 'jitteriness' (1), 'irritability' (3), 'depression' (1), 'anxiety' (1)

One dropout ('irritability') but it was not described in which trial it occurred (the publication reported from two trials, one with immediate and one with extended‐release methylphenidate)

Described in Biederman 2007 p 5, which reported data from the trial's interim analysis

Spencer 2003a

'Insomnia' (3), 'jittery' (2), 'anxiety' (2)

'Insomnia' (1)

Adverse events leading to drop out in more than two participants reported (FDA's Focalin labelling, p 12 of 21). The 'insomnia' event in the placebo group was described in Spencer 2007, calculated from 1.9%

Chronis‐Tuscano 2004

No dropouts

No dropouts

None

Rösler 2004

Not reported

Not reported

None

Medori 2005

11 participants experiencing 12 events: 'anxiety' (4), 'irritability' (3), 'nervousness' (3), 'restlessness' (2), 'insomnia' (2)

No events

Reasons for dropouts only reported for events experienced by two participants or more. We also included 'insomnia' although it is classified as a nervous system disorder in the table (MHRA 2010, p 59)

Winhusen 2005

No dropouts due to adverse events

No dropouts due to adverse events

None

Adler 2006

5 participants and 7 events: 'anxiety' (3), 'agitation', 'mood altered', 'panic attack', 'thinking abnormal' (1 each)

3 participants and 3 events: 'depressed mood' (2), 'depression' (1)

FDA Medical Review, p 103 of 456

Konstenius 2006

Not reported

Not reported

None

Compas 2007 CMCompas 2007 GPT

Not reported

Not reported

Only the number of participants who stopped MPH or placebo due to adverse events were reported (Philipsen 2015, Figure 1). Unclear if they dropped out of the study and type of adverse events not reported

Ginsberg 2007

No dropouts

No dropouts

None

Konstenius 2007

Not reported

Not reported

None

Casas 2008

'Insomnia' (5)

Not reported

Only the most common reason for dropout ('insomnia'), was reported in Casas 2013, p 275.

Retz 2008

Not reported

Not reported

None

Goodman 2009

2 participants: 'anxiety' (1), 'anxiety and insomnia' (1)

1 participant: 'suicidal ideation' (corresponding to the serious adverse event)

Goodman 2016, p 107

Weisler 2009

Not reported

Not reported

None

Huss 2010

47 reported participants: 'anxiety' (9), 'agitation' (5),' depressed mood' (5), 'depression' (5), 'insomnia' (5), 'irritability' (4), 'restlessness' (4), 'aggression' (2), 'apathy' (2), 'disturbance in attention' (2), 'impulse‐control disorder' (2), 'panic attack' (2)

4 reported participants: 'anxiety' (1), 'agitation' (1), 'depression' (1), 'panic attack' (1)

"Adverse event leading to dropout" reporting threshold: 0.4% (Clinical Trial Report, p 40) and 2% in Huss et al 2012

Takahashi 2011

Not reported

Not reported

None

Weiss 2014

'Anxiety' (2), 'insomnia' (2), 'affect lability' (1), 'emotional disorder' (1), 'irritability' (1)

'Irritability' (2)

FDA Clinical Review, table 13, p 35 of 57

AE: Adverse events. FDA: US Food and Drug Administration. P: page.

Flow diagram.
BfArM= Bundesinstitut für Arzneimittel und Medizinprodukte, FDA= US Food and Drug Administration, MEB= Medicines Evaluation Board, MHRA= Medicines and Healthcare products Regulatory Agency, TGA= Therapeutic Goods Administration, YODA= Yale University Open Data Access.

Figuras y tablas -
Figure 1

Flow diagram.
BfArM= Bundesinstitut für Arzneimittel und Medizinprodukte, FDA= US Food and Drug Administration, MEB= Medicines Evaluation Board, MHRA= Medicines and Healthcare products Regulatory Agency, TGA= Therapeutic Goods Administration, YODA= Yale University Open Data Access.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Funnel plot. Extended‐release methylphenidate versus placebo: ADHD symptoms (self‐rated).

Figuras y tablas -
Figure 3

Funnel plot. Extended‐release methylphenidate versus placebo: ADHD symptoms (self‐rated).

Funnel plot of comparison: 1 Extended‐release methylphenidate versus placebo ‐ primary outcomes (short and medium term), outcome: 1.8 Serious adverse events.

Figuras y tablas -
Figure 4

Funnel plot of comparison: 1 Extended‐release methylphenidate versus placebo ‐ primary outcomes (short and medium term), outcome: 1.8 Serious adverse events.

Funnel plot of comparison: 2 Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short‐ and medium‐term), outcome: 2.4 ADHD symptoms (investigator‐rated) (short‐term).

Figuras y tablas -
Figure 5

Funnel plot of comparison: 2 Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short‐ and medium‐term), outcome: 2.4 ADHD symptoms (investigator‐rated) (short‐term).

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 1: Days missed at work/school/training (week 13)

Figuras y tablas -
Analysis 1.1

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 1: Days missed at work/school/training (week 13)

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 2: Days missed at work/school/training (weeks 13‐26)

Figuras y tablas -
Analysis 1.2

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 2: Days missed at work/school/training (weeks 13‐26)

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 3: Days missed at work/school/training (weeks 26‐52)

Figuras y tablas -
Analysis 1.3

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 3: Days missed at work/school/training (weeks 26‐52)

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 4: ADHD symptoms (self‐rated) (short‐term)

Figuras y tablas -
Analysis 1.4

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 4: ADHD symptoms (self‐rated) (short‐term)

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 5: ADHD symptoms (self‐rated) [subgroup MD] (short‐term)

Figuras y tablas -
Analysis 1.5

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 5: ADHD symptoms (self‐rated) [subgroup MD] (short‐term)

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 6: ADHD symptoms (self‐rated) (medium‐term)

Figuras y tablas -
Analysis 1.6

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 6: ADHD symptoms (self‐rated) (medium‐term)

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 7: ADHD symptoms (self‐rated) [LMCF data] (medium‐term)

Figuras y tablas -
Analysis 1.7

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 7: ADHD symptoms (self‐rated) [LMCF data] (medium‐term)

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 8: Serious adverse events

Figuras y tablas -
Analysis 1.8

Comparison 1: Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term), Outcome 8: Serious adverse events

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 1: Quality of life (self‐rated) (short‐term)

Figuras y tablas -
Analysis 2.1

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 1: Quality of life (self‐rated) (short‐term)

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 2: Quality of life (self‐rated) [subgroup MD] (short‐term)

Figuras y tablas -
Analysis 2.2

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 2: Quality of life (self‐rated) [subgroup MD] (short‐term)

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 3: Quality of life (self‐rated) (medium‐term)

Figuras y tablas -
Analysis 2.3

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 3: Quality of life (self‐rated) (medium‐term)

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 4: ADHD symptoms (investigator rated) (short‐term)

Figuras y tablas -
Analysis 2.4

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 4: ADHD symptoms (investigator rated) (short‐term)

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 5: ADHD symptoms (investigator‐rated) [subgroup MD] (short‐term)

Figuras y tablas -
Analysis 2.5

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 5: ADHD symptoms (investigator‐rated) [subgroup MD] (short‐term)

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 6: ADHD symptoms (investigator‐rated) (medium‐term)

Figuras y tablas -
Analysis 2.6

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 6: ADHD symptoms (investigator‐rated) (medium‐term)

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 7: ADHD symptoms (investigator‐rated) [LMCF data] (medium‐term)

Figuras y tablas -
Analysis 2.7

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 7: ADHD symptoms (investigator‐rated) [LMCF data] (medium‐term)

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 8: ADHD symptoms (peer‐rated) (short‐term)

Figuras y tablas -
Analysis 2.8

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 8: ADHD symptoms (peer‐rated) (short‐term)

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 9: Cardiovascular: pulse (beats per minute)

Figuras y tablas -
Analysis 2.9

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 9: Cardiovascular: pulse (beats per minute)

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 10: Cardiovascular: systolic blood pressure

Figuras y tablas -
Analysis 2.10

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 10: Cardiovascular: systolic blood pressure

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 11: Cardiovascular: diastolic blood pressure

Figuras y tablas -
Analysis 2.11

Comparison 2: Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term), Outcome 11: Cardiovascular: diastolic blood pressure

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 1: Dropout (overall)

Figuras y tablas -
Analysis 3.1

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 1: Dropout (overall)

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 2: Dropout (due to adverse events)

Figuras y tablas -
Analysis 3.2

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 2: Dropout (due to adverse events)

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 3: Adverse events (proportion experiencing any adverse event)

Figuras y tablas -
Analysis 3.3

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 3: Adverse events (proportion experiencing any adverse event)

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 4: Psychiatric adverse events (proportion of participants)

Figuras y tablas -
Analysis 3.4

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 4: Psychiatric adverse events (proportion of participants)

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 5: Weight (change in kilograms)

Figuras y tablas -
Analysis 3.5

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 5: Weight (change in kilograms)

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 6: Adverse event: decreased appetite

Figuras y tablas -
Analysis 3.6

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 6: Adverse event: decreased appetite

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 7: Adverse event: dry mouth

Figuras y tablas -
Analysis 3.7

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 7: Adverse event: dry mouth

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 8: Adverse event: headache

Figuras y tablas -
Analysis 3.8

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 8: Adverse event: headache

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 9: Adverse event: palpitations

Figuras y tablas -
Analysis 3.9

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 9: Adverse event: palpitations

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 10: Adverse event: insomnia

Figuras y tablas -
Analysis 3.10

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 10: Adverse event: insomnia

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 11: Adverse event: sexual dysfunction

Figuras y tablas -
Analysis 3.11

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 11: Adverse event: sexual dysfunction

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 12: Adverse event: anxiety

Figuras y tablas -
Analysis 3.12

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 12: Adverse event: anxiety

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 13: Adverse event: depression

Figuras y tablas -
Analysis 3.13

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 13: Adverse event: depression

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 14: Adverse event: irritability

Figuras y tablas -
Analysis 3.14

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 14: Adverse event: irritability

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 15: Adverse event: feeling jittery

Figuras y tablas -
Analysis 3.15

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 15: Adverse event: feeling jittery

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 16: Adverse event: agitation

Figuras y tablas -
Analysis 3.16

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 16: Adverse event: agitation

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 17: Adverse event: aggression

Figuras y tablas -
Analysis 3.17

Comparison 3: Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term), Outcome 17: Adverse event: aggression

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 1: Overall dropout rate: psychiatric comorbidity (subgroup analysis)

Figuras y tablas -
Analysis 4.1

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 1: Overall dropout rate: psychiatric comorbidity (subgroup analysis)

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 2: Overall dropout rate: 'enriched design' (subgroup analysis)

Figuras y tablas -
Analysis 4.2

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 2: Overall dropout rate: 'enriched design' (subgroup analysis)

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 3: Overall dropout rate: withdrawal effects (subgroup analysis)

Figuras y tablas -
Analysis 4.3

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 3: Overall dropout rate: withdrawal effects (subgroup analysis)

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 4: Overall dropout rate: funding (subgroup analysis)

Figuras y tablas -
Analysis 4.4

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 4: Overall dropout rate: funding (subgroup analysis)

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 5: Proportion experiencing any adverse event: psychiatric comorbidity (subgroup analysis)

Figuras y tablas -
Analysis 4.5

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 5: Proportion experiencing any adverse event: psychiatric comorbidity (subgroup analysis)

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 6: Proportion experiencing any adverse event: withdrawal effects (subgroup analysis)

Figuras y tablas -
Analysis 4.6

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 6: Proportion experiencing any adverse event: withdrawal effects (subgroup analysis)

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 7: Proportion experiencing any adverse event: funding (subgroup analysis)

Figuras y tablas -
Analysis 4.7

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 7: Proportion experiencing any adverse event: funding (subgroup analysis)

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 8: Proportion experiencing any adverse event: dropout rates (sensitivity analysis)

Figuras y tablas -
Analysis 4.8

Comparison 4: Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses, Outcome 8: Proportion experiencing any adverse event: dropout rates (sensitivity analysis)

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 1: ADHD symptoms (self‐rated)

Figuras y tablas -
Analysis 5.1

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 1: ADHD symptoms (self‐rated)

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 2: Serious adverse events

Figuras y tablas -
Analysis 5.2

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 2: Serious adverse events

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 3: Adverse event: initial insomnia

Figuras y tablas -
Analysis 5.3

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 3: Adverse event: initial insomnia

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 4: Weight

Figuras y tablas -
Analysis 5.4

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 4: Weight

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 5: ADHD symptoms (investigator‐rated)

Figuras y tablas -
Analysis 5.5

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 5: ADHD symptoms (investigator‐rated)

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 6: Overall dropout

Figuras y tablas -
Analysis 5.6

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 6: Overall dropout

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 7: Adverse events (AE): proportion experiencing any AE

Figuras y tablas -
Analysis 5.7

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 7: Adverse events (AE): proportion experiencing any AE

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 8: Adverse events (leading to dropout)

Figuras y tablas -
Analysis 5.8

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 8: Adverse events (leading to dropout)

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 9: Adverse event: headache

Figuras y tablas -
Analysis 5.9

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 9: Adverse event: headache

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 10: Adverse event: decreased appetite

Figuras y tablas -
Analysis 5.10

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 10: Adverse event: decreased appetite

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 11: Adverse event: irritability

Figuras y tablas -
Analysis 5.11

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 11: Adverse event: irritability

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 12: Adverse event: dry mouth

Figuras y tablas -
Analysis 5.12

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 12: Adverse event: dry mouth

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 13: Adverse event: decreased libido

Figuras y tablas -
Analysis 5.13

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 13: Adverse event: decreased libido

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 14: Adverse event: feeling jittery

Figuras y tablas -
Analysis 5.14

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 14: Adverse event: feeling jittery

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 15: Adverse events: palpitations

Figuras y tablas -
Analysis 5.15

Comparison 5: Extended‐release methylphenidate versus atomoxetine, Outcome 15: Adverse events: palpitations

Comparison 6: Extended‐release methylphenidate versus bupropion, Outcome 1: ADHD symptoms (self‐rated)

Figuras y tablas -
Analysis 6.1

Comparison 6: Extended‐release methylphenidate versus bupropion, Outcome 1: ADHD symptoms (self‐rated)

Comparison 6: Extended‐release methylphenidate versus bupropion, Outcome 2: Overall dropout

Figuras y tablas -
Analysis 6.2

Comparison 6: Extended‐release methylphenidate versus bupropion, Outcome 2: Overall dropout

Comparison 6: Extended‐release methylphenidate versus bupropion, Outcome 3: Dropouts due to adverse events

Figuras y tablas -
Analysis 6.3

Comparison 6: Extended‐release methylphenidate versus bupropion, Outcome 3: Dropouts due to adverse events

Summary of findings 1. Extended‐release methylphenidate compared to placebo for ADHD

Extended‐release methylphenidate compared to placebo for ADHD

Patient or population: adults diagnosed with ADHD
Setting: outpatient setting
Intervention: extended‐release methylphenidate
Comparison: placebo

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with placebo

Risk with extended‐release methylphenidate

Functional outcome:days missed at work/ school/ training

 

Time of assessment: 13 weeks

The mean number of days missed at work, school or training in the control group was 2.4 

The mean number of days missed at work, school or training was 0.15 days fewer
(2.11 fewer to 1.81 more)

409
(1 RCT)

⊕⊝⊝⊝
Very lowa,b

ADHD symptoms (self‐rated)

 

Time of assessment: median 8 weeks (range 2 ‐ 26)

The mean ADHD score in the intervention groups was 0.37 SDlower
(0.43 lower to 0.30 lower)

3799
(16 RCTs)

⊕⊝⊝⊝
Very lowa,b

An SMD of 0.37 may be considered a small‐to‐moderate effect size

Serious adverse events

 

Time of assessment: median 8 weeks (range 4 ‐ 52)

Study population

RR1.43
(0.85 to 2.43)

4078
(14 RCTs)

⊕⊝⊝⊝
Very lowa,b

12 per 1000

17 per 1000
(10 to 30)

Quality of life (self‐rated)

 

Time of assessment: median 6 weeks (range 4 ‐ 52)

The mean quality of life score in the intervention groups was 0.15 SD lower (0.25 lower to 0.05 lower)

1888
(6 RCTs)

⊕⊝⊝⊝
Very lowa,b

An SMD of 0.15 may be considered a small effect size

ADHD symptoms (investigator‐rated)

 

Time of assessment: median 8 weeks (range 2 ‐ 26)

The mean investigator‐rated ADHD score in the intervention groups was 0.42 SD lower
(0.49 lower to 0.36 lower)

4183
(18 RCTs)

⊕⊝⊝⊝
Very lowa,b

An SMD of 0.42 may be considered a small‐to‐moderate effect size

ADHD symptoms (peer‐rated)

 

Time of assessment: median 7.5 weeks (range 6 ‐ 9)

The mean peer‐rated ADHD score in the intervention groups was 0.31 SD lower
(0.48 lower to 0.14 lower)

1005
(3 RCTs)

⊕⊝⊝⊝
Very lowa,b

An SMD of 0.31 may be considered a small‐to‐moderate effect size

Adverse events (proportion experiencing any adverse event)

 

Time of assessment: median 8 weeks (range 4 ‐ 52)

Study population

RR1.27
(1.19 to 1.37)

4214
(14 RCTs)

⊕⊝⊝⊝
Very lowa,b

641 per 1000

814 per 1000
(763 to 878)

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
ADHD: Attention deficit hyperactivity disorder; CI: Confidence interval; RCT: Randomised controlled trial; RR: Risk ratio; SD: Standard deviation; SMD: Standardised mean difference.

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect
Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect

aWe downgraded two levels due to risk bias; primarily due to blinding issues caused by methylphenidate's effects, high attrition (dropout) rates, and selective reporting of the included trials.
bWe downgraded two levels due to indirectness; 19 of 21 trials had limited generalisability due to strict inclusion of allowed psychiatric comorbidity; 19 of 21 trials used an 'enriched design' thereby excluding potential participants with previous poor response to methylphenidate; and 16 of 21 trials were at risk of being confounded by withdrawal effects since participants were asked to stop concurring CNS stimulant use prior to randomisation. In addition, 18 of 21 trials had a short follow‐up between 2 to 13 weeks.

Figuras y tablas -
Summary of findings 1. Extended‐release methylphenidate compared to placebo for ADHD
Comparison 1. Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Days missed at work/school/training (week 13) Show forest plot

2

409

Mean Difference (IV, Random, 95% CI)

‐0.15 [‐2.11, 1.81]

1.2 Days missed at work/school/training (weeks 13‐26) Show forest plot

2

327

Mean Difference (IV, Random, 95% CI)

‐0.42 [‐2.48, 1.64]

1.3 Days missed at work/school/training (weeks 26‐52) Show forest plot

2

292

Mean Difference (IV, Random, 95% CI)

0.71 [‐1.61, 3.03]

1.4 ADHD symptoms (self‐rated) (short‐term) Show forest plot

17

3799

Std. Mean Difference (IV, Random, 95% CI)

‐0.37 [‐0.43, ‐0.30]

1.5 ADHD symptoms (self‐rated) [subgroup MD] (short‐term) Show forest plot

17

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.5.1 DSM‐IV Total ADHD (18 items, 0‐54 points)

7

1189

Mean Difference (IV, Random, 95% CI)

‐3.05 [‐4.34, ‐1.76]

1.5.2 ASRS (18 items, 0‐72 points)

2

953

Mean Difference (IV, Random, 95% CI)

‐6.25 [‐8.25, ‐4.25]

1.5.3 CAARS: short version (26 items, 0‐78 points)

5

1451

Mean Difference (IV, Random, 95% CI)

‐5.21 [‐7.14, ‐3.29]

1.5.4 CAARS: long version (66 items, 0‐90 points)

1

162

Mean Difference (IV, Random, 95% CI)

‐28.40 [‐48.28, ‐8.52]

1.5.5 CAARS: unspecified subscale

2

44

Mean Difference (IV, Random, 95% CI)

‐8.23 [‐17.79, 1.32]

1.6 ADHD symptoms (self‐rated) (medium‐term) Show forest plot

2

234

Mean Difference (IV, Random, 95% CI)

‐1.59 [‐4.26, 1.09]

1.7 ADHD symptoms (self‐rated) [LMCF data] (medium‐term) Show forest plot

2

419

Mean Difference (IV, Random, 95% CI)

‐2.23 [‐3.50, ‐0.95]

1.8 Serious adverse events Show forest plot

14

4078

Risk Ratio (IV, Random, 95% CI)

1.43 [0.85, 2.43]

Figuras y tablas -
Comparison 1. Extended‐release methylphenidate versus placebo ‐ primary outcomes (short‐ and medium‐term)
Comparison 2. Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Quality of life (self‐rated) (short‐term) Show forest plot

7

1888

Std. Mean Difference (IV, Random, 95% CI)

‐0.15 [‐0.25, ‐0.05]

2.2 Quality of life (self‐rated) [subgroup MD] (short‐term) Show forest plot

7

Mean Difference (IV, Random, 95% CI)

Subtotals only

2.2.1 Q‐LES‐QSF (14‐70 points)

5

1234

Mean Difference (IV, Random, 95% CI)

‐0.93 [‐2.17, 0.31]

2.2.2 AIM‐A total score

1

279

Mean Difference (IV, Random, 95% CI)

‐0.50 [‐0.99, ‐0.00]

2.2.3 AAQOL

1

375

Mean Difference (IV, Random, 95% CI)

‐6.10 [‐10.67, ‐1.53]

2.3 Quality of life (self‐rated) (medium‐term) Show forest plot

2

419

Mean Difference (IV, Random, 95% CI)

‐0.66 [‐2.97, 1.64]

2.4 ADHD symptoms (investigator rated) (short‐term) Show forest plot

19

4183

Std. Mean Difference (IV, Random, 95% CI)

‐0.42 [‐0.49, ‐0.36]

2.5 ADHD symptoms (investigator‐rated) [subgroup MD] (short‐term) Show forest plot

19

Mean Difference (IV, Random, 95% CI)

Subtotals only

2.5.1 DSM‐IV Total ADHD (18 items, 0‐54 points)

12

3121

Mean Difference (IV, Random, 95% CI)

‐4.74 [‐5.65, ‐3.84]

2.5.2 DSM‐5 Total ADHD (18 items, 0‐54 points)

1

375

Mean Difference (IV, Random, 95% CI)

‐4.38 [‐7.37, ‐1.39]

2.5.3 WRAADDS (28 items, 0‐56 points)

2

521

Mean Difference (IV, Random, 95% CI)

‐6.06 [‐8.48, ‐3.63]

2.5.4 CGI (range 0‐7)

2

36

Mean Difference (IV, Random, 95% CI)

0.09 [‐0.67, 0.86]

2.5.5 TAADS (7 items, 0‐28 points)

1

106

Mean Difference (IV, Random, 95% CI)

‐3.50 [‐7.85, 0.85]

2.5.6 CAARS: unspecified scale

1

24

Mean Difference (IV, Random, 95% CI)

0.10 [‐10.21, 10.41]

2.6 ADHD symptoms (investigator‐rated) (medium‐term) Show forest plot

2

243

Mean Difference (IV, Random, 95% CI)

‐1.29 [‐3.38, 0.80]

2.7 ADHD symptoms (investigator‐rated) [LMCF data] (medium‐term) Show forest plot

2

419

Mean Difference (IV, Random, 95% CI)

‐2.18 [‐3.55, ‐0.80]

2.8 ADHD symptoms (peer‐rated) (short‐term) Show forest plot

3

1005

Std. Mean Difference (IV, Random, 95% CI)

‐0.31 [‐0.48, ‐0.14]

2.9 Cardiovascular: pulse (beats per minute) Show forest plot

11

2558

Mean Difference (IV, Random, 95% CI)

4.64 [3.13, 6.15]

2.10 Cardiovascular: systolic blood pressure Show forest plot

10

2276

Mean Difference (IV, Random, 95% CI)

1.11 [‐0.06, 2.27]

2.11 Cardiovascular: diastolic blood pressure Show forest plot

10

2276

Mean Difference (IV, Random, 95% CI)

1.24 [0.04, 2.44]

Figuras y tablas -
Comparison 2. Extended‐release methylphenidate versus placebo ‐ secondary outcomes (short and medium term)
Comparison 3. Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

3.1 Dropout (overall) Show forest plot

22

4769

Risk Ratio (IV, Random, 95% CI)

1.01 [0.84, 1.21]

3.2 Dropout (due to adverse events) Show forest plot

15

3963

Risk Ratio (IV, Random, 95% CI)

2.36 [1.62, 3.43]

3.3 Adverse events (proportion experiencing any adverse event) Show forest plot

14

4214

Risk Ratio (IV, Random, 95% CI)

1.27 [1.19, 1.37]

3.4 Psychiatric adverse events (proportion of participants) Show forest plot

7

2737

Risk Ratio (IV, Random, 95% CI)

1.83 [1.43, 2.34]

3.5 Weight (change in kilograms) Show forest plot

10

2302

Mean Difference (IV, Random, 95% CI)

‐1.78 [‐2.36, ‐1.20]

3.6 Adverse event: decreased appetite Show forest plot

16

4491

Risk Ratio (IV, Random, 95% CI)

4.08 [3.34, 4.98]

3.7 Adverse event: dry mouth Show forest plot

16

4491

Risk Ratio (IV, Random, 95% CI)

3.36 [2.61, 4.34]

3.8 Adverse event: headache Show forest plot

16

4238

Risk Ratio (IV, Random, 95% CI)

1.35 [1.18, 1.54]

3.9 Adverse event: palpitations Show forest plot

15

4265

Risk Ratio (IV, Random, 95% CI)

3.67 [2.42, 5.57]

3.10 Adverse event: insomnia Show forest plot

16

4435

Risk Ratio (IV, Random, 95% CI)

1.97 [1.51, 2.57]

3.11 Adverse event: sexual dysfunction Show forest plot

7

3057

Risk Ratio (IV, Random, 95% CI)

2.66 [1.31, 5.39]

3.12 Adverse event: anxiety Show forest plot

13

3829

Risk Ratio (IV, Random, 95% CI)

2.23 [1.40, 3.57]

3.13 Adverse event: depression Show forest plot

7

2791

Risk Ratio (IV, Random, 95% CI)

1.47 [0.87, 2.49]

3.14 Adverse event: irritability Show forest plot

11

3377

Risk Ratio (IV, Random, 95% CI)

1.39 [1.00, 1.93]

3.15 Adverse event: feeling jittery Show forest plot

7

2254

Risk Ratio (IV, Random, 95% CI)

5.52 [2.77, 10.99]

3.16 Adverse event: agitation Show forest plot

8

3166

Risk Ratio (IV, Random, 95% CI)

2.16 [1.25, 3.71]

3.17 Adverse event: aggression Show forest plot

2

1319

Risk Ratio (IV, Random, 95% CI)

2.10 [1.32, 3.33]

Figuras y tablas -
Comparison 3. Extended‐release methylphenidate versus placebo ‐ secondary outcomes: adverse events (short‐ and medium‐term)
Comparison 4. Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4.1 Overall dropout rate: psychiatric comorbidity (subgroup analysis) Show forest plot

22

4769

Risk Ratio (IV, Random, 95% CI)

1.01 [0.84, 1.21]

4.1.1 Low risk

1

54

Risk Ratio (IV, Random, 95% CI)

0.74 [0.53, 1.03]

4.1.2 Unclear risk

1

30

Risk Ratio (IV, Random, 95% CI)

Not estimable

4.1.3 High risk

20

4685

Risk Ratio (IV, Random, 95% CI)

1.04 [0.86, 1.25]

4.2 Overall dropout rate: 'enriched design' (subgroup analysis) Show forest plot

22

4769

Risk Ratio (IV, Random, 95% CI)

1.01 [0.84, 1.21]

4.2.1 Unclear risk

2

247

Risk Ratio (IV, Random, 95% CI)

1.02 [0.26, 3.98]

4.2.2 High risk

20

4522

Risk Ratio (IV, Random, 95% CI)

0.99 [0.83, 1.19]

4.3 Overall dropout rate: withdrawal effects (subgroup analysis) Show forest plot

22

4769

Risk Ratio (IV, Random, 95% CI)

1.01 [0.84, 1.21]

4.3.1 Low risk

1

357

Risk Ratio (IV, Random, 95% CI)

0.91 [0.61, 1.34]

4.3.2 Unclear risk

5

822

Risk Ratio (IV, Random, 95% CI)

0.90 [0.62, 1.30]

4.3.3 High risk

16

3590

Risk Ratio (IV, Random, 95% CI)

1.07 [0.85, 1.34]

4.4 Overall dropout rate: funding (subgroup analysis) Show forest plot

22

4769

Risk Ratio (IV, Random, 95% CI)

1.01 [0.84, 1.21]

4.4.1 Industry funded

13

3782

Risk Ratio (IV, Random, 95% CI)

1.14 [0.88, 1.47]

4.4.2 Publicly funded with industry involvement

3

688

Risk Ratio (IV, Random, 95% CI)

0.73 [0.59, 0.91]

4.4.3 Publicly funded

5

279

Risk Ratio (IV, Random, 95% CI)

0.99 [0.70, 1.40]

4.4.4 Unclear funding

1

20

Risk Ratio (IV, Random, 95% CI)

0.33 [0.04, 2.69]

4.5 Proportion experiencing any adverse event: psychiatric comorbidity (subgroup analysis) Show forest plot

14

4214

Risk Ratio (IV, Random, 95% CI)

1.27 [1.19, 1.37]

4.5.1 High

13

4184

Risk Ratio (IV, Random, 95% CI)

1.26 [1.18, 1.36]

4.5.2 Unclear

1

30

Risk Ratio (IV, Random, 95% CI)

2.40 [1.12, 5.13]

4.6 Proportion experiencing any adverse event: withdrawal effects (subgroup analysis) Show forest plot

14

4214

Risk Ratio (IV, Random, 95% CI)

1.27 [1.19, 1.37]

4.6.1 High

11

3310

Risk Ratio (IV, Random, 95% CI)

1.28 [1.18, 1.38]

4.6.2 Unclear

2

555

Risk Ratio (IV, Random, 95% CI)

1.21 [0.95, 1.53]

4.6.3 Low

1

349

Risk Ratio (IV, Random, 95% CI)

1.46 [1.22, 1.74]

4.7 Proportion experiencing any adverse event: funding (subgroup analysis) Show forest plot

14

4214

Risk Ratio (IV, Random, 95% CI)

1.27 [1.19, 1.37]

4.7.1 Industry funded

12

3545

Risk Ratio (IV, Random, 95% CI)

1.32 [1.23, 1.41]

4.7.2 Publicly funded with industry involvement

2

669

Risk Ratio (IV, Random, 95% CI)

1.09 [1.05, 1.14]

4.8 Proportion experiencing any adverse event: dropout rates (sensitivity analysis) Show forest plot

14

4214

Risk Ratio (IV, Random, 95% CI)

1.27 [1.19, 1.37]

4.8.1 High

10

3363

Risk Ratio (IV, Random, 95% CI)

1.21 [1.14, 1.29]

4.8.2 Unclear

1

375

Risk Ratio (IV, Random, 95% CI)

1.46 [1.12, 1.89]

4.8.3 Low

3

476

Risk Ratio (IV, Random, 95% CI)

1.56 [1.35, 1.81]

Figuras y tablas -
Comparison 4. Extended‐release methylphenidate versus placebo: subgroup and sensitivity analyses
Comparison 5. Extended‐release methylphenidate versus atomoxetine

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

5.1 ADHD symptoms (self‐rated) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

5.2 Serious adverse events Show forest plot

1

Risk Ratio (IV, Random, 95% CI)

Totals not selected

5.3 Adverse event: initial insomnia Show forest plot

1

Risk Ratio (IV, Random, 95% CI)

Totals not selected

5.4 Weight Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

5.5 ADHD symptoms (investigator‐rated) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

5.6 Overall dropout Show forest plot

1

Risk Ratio (IV, Random, 95% CI)

Totals not selected

5.7 Adverse events (AE): proportion experiencing any AE Show forest plot

1

Risk Ratio (IV, Random, 95% CI)

Totals not selected

5.8 Adverse events (leading to dropout) Show forest plot

1

Risk Ratio (IV, Random, 95% CI)

Totals not selected

5.9 Adverse event: headache Show forest plot

1

Risk Ratio (IV, Random, 95% CI)

Totals not selected

5.10 Adverse event: decreased appetite Show forest plot

1

Risk Ratio (IV, Random, 95% CI)

Totals not selected

5.11 Adverse event: irritability Show forest plot

1

Risk Ratio (IV, Random, 95% CI)

Totals not selected

5.12 Adverse event: dry mouth Show forest plot

1

Risk Ratio (IV, Random, 95% CI)

Totals not selected

5.13 Adverse event: decreased libido Show forest plot

1

Risk Ratio (IV, Random, 95% CI)

Totals not selected

5.14 Adverse event: feeling jittery Show forest plot

1

Risk Ratio (IV, Random, 95% CI)

Totals not selected

5.15 Adverse events: palpitations Show forest plot

1

Risk Ratio (IV, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 5. Extended‐release methylphenidate versus atomoxetine
Comparison 6. Extended‐release methylphenidate versus bupropion

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

6.1 ADHD symptoms (self‐rated) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

6.2 Overall dropout Show forest plot

1

Risk Ratio (IV, Random, 95% CI)

Totals not selected

6.3 Dropouts due to adverse events Show forest plot

1

Risk Ratio (IV, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 6. Extended‐release methylphenidate versus bupropion