Nonstimulant Medications for Attention-Deficit/Hyperactivity Disorder (ADHD) in Adults: Systematic Review and Meta-analysis
Radonjić, Nevena V; Bellato, Alessio; Khoury, Nayla M; Cortese, Samuele; Faraone, Stephen V
BACKGROUND:For some adults with Attention-Deficit/Hyperactivity Disorder (ADHD), nonstimulants need to be considered either as a monotherapy or as an adjunct to stimulants. OBJECTIVES:The objectives of this systematic review and meta-analysis were to assess the efficacy, acceptability, and tolerability of nonstimulants in adults with ADHD. METHODS:Data sources, searches, and study selection were based on a previously published network meta-analysis of randomized clinical trials (RCTs) by Cortese at al. (Lancet Psychiatry 5(9):727-738, 2018), which we updated in March 2022. Specifically, we searched PubMed, BIOSIS Previews, CINAHL, the Cochrane Central Register of Controlled Trials, EMBASE, ERIC, MEDLINE, PsycINFO, OpenGrey, Web of Science Core Collection, ProQuest Dissertations and Theses (UK and Ireland), ProQuest Dissertations and Theses (abstracts and international), and the WHO International Trials Registry Platform, including ClinicalTrials.gov for double-blind RCTs with a placebo arm, lasting at least one week, including adults with a diagnosis of ADHD based on DSM-III, DSM-III-R, DSM-IV(TR), DSM-5 or ICD-9- or 10, and reporting data on efficacy, tolerability (drop-out due to side effects) and acceptability (drop-out due to any cause) of guanfacine, clonidine, or atomoxetine. Additionally, we searched for RCTs of viloxazine extended release (ER), approved for ADHD in 2021. Random-effects meta-analyses were conducted, and the risk of bias for individual RCTs was assessed using the Cochrane Risk of Bias tool. RESULTS:We included 18 studies in the meta-analyses (4308 participants) plus one additional study in the narrative synthesis (374 participants). The meta-analysis showed that atomoxetine (15 RCTs) (Hedge's g = - 0.48, 95% CI [- 0.64; - 0.33]), guanfacine (two RCTs) (Hedge's g = - 0.66, 95% CI [- 0.94; - 0.38]) and viloxazine ER (one RCT) were significantly more efficacious than placebo. Atomoxetine was less well tolerated than placebo, while tolerability of guanfacine and viloxazine ER could not be meta-analysed, since only one study, for each medication, reported on it. CONCLUSIONS:All investigated nonstimulants were more efficacious in the treatment of ADHD in adults, than placebo, while the placebo had better acceptability and tolerability. PROTOCOL:https://osf.io/5vnmt/?view_only=2bf87ed12ba94645babedceeee4c0120 .
PMID: 37166701
ISSN: 1179-1934
CID: 5503362
Validation of the Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) questionnaire for adults
Solmi, Marco; Thompson, Trevor; Estradé, Andrés; Agorastos, Agorastos; Radua, Joaquim; Cortese, Samuele; Dragioti, Elena; Leisch, Friedrich; Vancampfort, Davy; Thygesen, Lau Caspar; Aschauer, Harald; Schlögelhofer, Monika; Aschauer, Elena; Schneeberger, Andres; Huber, Christian G; Hasler, Gregor; Conus, Philippe; Do Cuénod, Kim Q; von Känel, Roland; Arrondo, Gonzalo; Fusar-Poli, Paolo; Gorwood, Philip; Llorca, Pierre-Michel; Krebs, Marie-Odile; Scanferla, Elisabetta; Kishimoto, Taishiro; Rabbani, Golam; Skonieczna-Żydecka, Karolina; Brambilla, Paolo; Favaro, Angela; Takamiya, Akihiro; Zoccante, Leonardo; Colizzi, Marco; Bourgin, Julie; Kamiński, Karol; Moghadasin, Maryam; Seedat, Soraya; Matthews, Evan; Wells, John; Vassilopoulou, Emilia; Gadelha, Ary; Su, Kuan-Pin; Kwon, Jun Soo; Kim, Minah; Lee, Tae Young; Papsuev, Oleg; Manková, Denisa; Boscutti, Andrea; Gerunda, Cristiano; Saccon, Diego; Righi, Elena; Monaco, Francesco; Croatto, Giovanni; Cereda, Guido; Demurtas, Jacopo; Brondino, Natascia; Veronese, Nicola; Enrico, Paolo; Politi, Pierluigi; Ciappolino, Valentina; Pfennig, Andrea; Bechdolf, Andreas; Meyer-Lindenberg, Andreas; Kahl, Kai G; Domschke, Katharina; Bauer, Michael; Koutsouleris, Nikolaos; Winter, Sibylle; Borgwardt, Stefan; Bitter, Istvan; Balazs, Judit; Czobor, Pál; Unoka, Zsolt; Mavridis, Dimitris; Tsamakis, Konstantinos; Bozikas, Vasilios P; Tunvirachaisakul, Chavit; Maes, Michael; Rungnirundorn, Teerayuth; Supasitthumrong, Thitiporn; Haque, Ariful; Brunoni, Andre R; Costardi, Carlos Gustavo; Schuch, Felipe Barreto; Polanczyk, Guilherme; Luiz, Jhoanne Merlyn; Fonseca, Lais; Aparicio, Luana V; Valvassori, Samira S; Nordentoft, Merete; Vendsborg, Per; Hoffmann, Sofie Have; Sehli, Jihed; Sartorius, Norman; Heuss, Sabina; Guinart, Daniel; Hamilton, Jane; Kane, John; Rubio, Jose; Sand, Michael; Koyanagi, Ai; Solanes, Aleix; Andreu-Bernabeu, Alvaro; Cáceres, Antonia San José; Arango, Celso; Díaz-Caneja, Covadonga M; Hidalgo-Mazzei, Diego; Vieta, Eduard; Gonzalez-Peñas, Javier; Fortea, Lydia; Parellada, Mara; Fullana, Miquel A; Verdolini, Norma; Andrlíková, Eva; Janků, Karolina; Millan, Mark John; Honciuc, Mihaela; Moniuszko-Malinowska, Anna; Łoniewski, Igor; Samochowiec, Jerzy; Kiszkiel, Łukasz; Marlicz, Maria; Sowa, Paweł; Marlicz, Wojciech; Spies, Georgina; Stubbs, Brendon; Firth, Joseph; Sullivan, Sarah; Darcin, Asli Enez; Aksu, Hatice; Dilbaz, Nesrin; Noyan, Onur; Kitazawa, Momoko; Kurokawa, Shunya; Tazawa, Yuki; Anselmi, Alejandro; Cracco, Cecilia; Machado, Ana Inés; Estrade, Natalia; De Leo, Diego; Curtis, Jackie; Berk, Michael; Ward, Philip; Teasdale, Scott; Rosenbaum, Simon; Marx, Wolfgang; Horodnic, Adrian Vasile; Oprea, Liviu; Alexinschi, Ovidiu; Ifteni, Petru; Turliuc, Serban; Ciuhodaru, Tudor; Bolos, Alexandra; Matei, Valentin; Nieman, Dorien H; Sommer, Iris; van Os, Jim; van Amelsvoort, Therese; Sun, Ching-Fang; Guu, Ta-Wei; Jiao, Can; Zhang, Jieting; Fan, Jialin; Zou, Liye; Yu, Xin; Chi, Xinli; de Timary, Philippe; van Winkel, Ruud; Ng, Bernardo; Pena, Edilberto; Arellano, Ramon; Roman, Raquel; Sanchez, Thelma; Movina, Larisa; Morgado, Pedro; Brissos, Sofia; Aizberg, Oleg; Mosina, Anna; Krinitski, Damir; Mugisha, James; Sadeghi-Bahmani, Dena; Sheybani, Farshad; Sadeghi, Masoud; Hadi, Samira; Brand, Serge; Errazuriz, Antonia; Crossley, Nicolas; Ristic, Dragana Ignjatovic; López-Jaramillo, Carlos; Efthymiou, Dimitris; Kuttichira, Praveenlal; Kallivayalil, Roy Abraham; Javed, Afzal; Afridi, Muhammad Iqbal; James, Bawo; Seb-Akahomen, Omonefe Joy; Fiedorowicz, Jess; Carvalho, Andre F; Daskalakis, Jeff; Yatham, Lakshmi N; Yang, Lin; Okasha, Tarek; Dahdouh, Aïcha; Gerdle, Björn; Tiihonen, Jari; Shin, Jae Il; Lee, Jinhee; Mhalla, Ahmed; Gaha, Lotfi; Brahim, Takoua; Altynbekov, Kuanysh; Negay, Nikolay; Nurmagambetova, Saltanat; Jamei, Yasser Abu; Weiser, Mark; Correll, Christoph U
BACKGROUND:The Collaborative Outcome study on Health and Functioning during Infection Times (COH-FIT; www.coh-fit.com) is an anonymous and global online survey measuring health and functioning during the COVID-19 pandemic. The aim of this study was to test concurrently the validity of COH-FIT items and the internal validity of the co-primary outcome, a composite psychopathology "P-score". METHODS:The COH-FIT survey has been translated into 30 languages (two blind forward-translations, consensus, one independent English back-translation, final harmonization). To measure mental health, 1-4 items ("COH-FIT items") were extracted from validated questionnaires (e.g. Patient Health Questionnaire 9). COH-FIT items measured anxiety, depressive, post-traumatic, obsessive-compulsive, bipolar and psychotic symptoms, as well as stress, sleep and concentration. COH-FIT Items which correlated r ≥ 0.5 with validated companion questionnaires, were initially retained. A P-score factor structure was then identified from these items using exploratory factor analysis (EFA) and confirmatory factor analyses (CFA) on data split into training and validation sets. Consistency of results across languages, gender and age was assessed. RESULTS:From >150,000 adult responses by May 6th, 2022, a subset of 22,456 completed both COH-FIT items and validated questionnaires. Concurrent validity was consistently demonstrated across different languages for COH-FIT items. CFA confirmed EFA results of five first-order factors (anxiety, depression, post-traumatic, psychotic, psychophysiologic symptoms) and revealed a single second-order factor P-score, with high internal reliability (ω = 0.95). Factor structure was consistent across age and sex. CONCLUSIONS:COH-FIT is a valid instrument to globally measure mental health during infection times. The P-score is a valid measure of multidimensional mental health.
PMCID:9794522
PMID: 36586617
ISSN: 1573-2517
CID: 5442082