TY - JOUR
T1 - Systematic review of quality of life and functional outcomes in randomized placebo-controlled studies of medications for attention-deficit/hyperactivity disorder
AU - Coghill, David R.
AU - Banaschewski, Tobias
AU - Soutullo, César
AU - Cottingham, Matthew G.
AU - Zuddas, Alessandro
N1 - This systematic review was funded by Shire International GmbH. Shire develops and markets medications for ADHD. The following authors have received compensation for serving as consultants or speakers for, or they or the institutions they work for have received research support or royalties from, the companies or organizations indicated: T Banaschewski (Bristol-Myers Squibb, Develco Pharma, Janssen McNeil, Lilly, Medice, Novartis, Shire and Vifor Pharma); DR Coghill (Eli Lilly, Flynn Pharma, Janssen-Cilag, Medice, Novartis, Otsuka, Oxford University Press, Pfizer, Schering-Plough, Shire, UCB and Vifor Pharma); C Soutullo (Alicia Koplowitz Foundation, Editorial Médica Panamericana, Eli Lilly, EUNSA [University of Navarra Press], Fundación Caja Navarra, Janssen, Lundbeck, Mayo Eds, Medice/Juste, Rubiò, Shire, University of Navarra Research Projects [PIUNA] and Wolters Kluwer); A Zuddas (AstraZeneca, Giunti OS, Lilly, Lundbeck, Otsuka, Oxford University Press, Roche, Shire and Vifor Pharma). MG Cottingham is an employee of Oxford PharmaGenesis. Oxford PharmaGenesis received funding from Shire International GmbH for this systematic review, including assistance in screening, formatting, proofreading, copy-editing and fact checking
PY - 2017/11
Y1 - 2017/11
N2 - Children, adolescents and adults with attention-deficit/hyperactivity disorder (ADHD) experience functional impairment and poor health-related quality of life (HRQoL) in addition to symptoms of inattention/hyperactivity-impulsivity. To synthesize qualitatively the published evidence from randomized, double-blind, placebo-controlled trials of the effectiveness of pharmacotherapy on functional impairment or HRQoL in patients with ADHD, a systematic PubMed searching and screening strategy was designed to identify journal articles meeting pre-specified criteria. Post hoc analyses and meta-analyses were excluded. HRQoL outcomes, functional outcomes and the principal ADHD symptom-based outcome were extracted from included studies. An effect size of 0.5 versus placebo was used as a threshold for potential clinical relevance (unreported effect sizes were calculated when possible). Of 291 records screened, 35 articles describing 34 studies were included. HRQoL/functioning was usually self-rated in adults and proxy-rated in children/adolescents. Baseline data indicated substantial HRQoL deficits in children/adolescents. Placebo-adjusted effects of medication on ADHD symptoms, HRQoL and functioning, respectively, were statistically or nominally significant in 18/18, 10/12 and 7/9 studies in children/adolescents and 14/16, 9/11 and 9/10 studies in adults. Effect sizes were ≥0.5 versus placebo for symptoms, HRQoL and functioning, respectively, in 14/16, 7/9 and 4/8 studies in children/adolescents; and 6/12, 1/6 and 1/8 studies in adults. Effect sizes were typically larger for stimulants than for non-stimulants, for symptoms than for HRQoL/functioning, and for children/adolescents than for adults. The efficacy of ADHD medication extends beyond symptom control and may help reduce the related but distinct functional impairments and HRQoL deficits in patients with ADHD.
AB - Children, adolescents and adults with attention-deficit/hyperactivity disorder (ADHD) experience functional impairment and poor health-related quality of life (HRQoL) in addition to symptoms of inattention/hyperactivity-impulsivity. To synthesize qualitatively the published evidence from randomized, double-blind, placebo-controlled trials of the effectiveness of pharmacotherapy on functional impairment or HRQoL in patients with ADHD, a systematic PubMed searching and screening strategy was designed to identify journal articles meeting pre-specified criteria. Post hoc analyses and meta-analyses were excluded. HRQoL outcomes, functional outcomes and the principal ADHD symptom-based outcome were extracted from included studies. An effect size of 0.5 versus placebo was used as a threshold for potential clinical relevance (unreported effect sizes were calculated when possible). Of 291 records screened, 35 articles describing 34 studies were included. HRQoL/functioning was usually self-rated in adults and proxy-rated in children/adolescents. Baseline data indicated substantial HRQoL deficits in children/adolescents. Placebo-adjusted effects of medication on ADHD symptoms, HRQoL and functioning, respectively, were statistically or nominally significant in 18/18, 10/12 and 7/9 studies in children/adolescents and 14/16, 9/11 and 9/10 studies in adults. Effect sizes were ≥0.5 versus placebo for symptoms, HRQoL and functioning, respectively, in 14/16, 7/9 and 4/8 studies in children/adolescents; and 6/12, 1/6 and 1/8 studies in adults. Effect sizes were typically larger for stimulants than for non-stimulants, for symptoms than for HRQoL/functioning, and for children/adolescents than for adults. The efficacy of ADHD medication extends beyond symptom control and may help reduce the related but distinct functional impairments and HRQoL deficits in patients with ADHD.
KW - Attention-deficit/hyperactivity disorder
KW - Quality of life
KW - Functional impairment
KW - Randomized clinical trials
KW - Systematic review
U2 - 10.1007/s00787-017-0986-y
DO - 10.1007/s00787-017-0986-y
M3 - Review article
C2 - 28429134
SN - 1018-8827
VL - 26
SP - 1283
EP - 1307
JO - European Child & Adolescent Psychiatry
JF - European Child & Adolescent Psychiatry
IS - 11
ER -