哌醋甲酯和托莫西汀治疗注意缺陷多动障碍的疗效与安全性的系统评价

Effectiveness and safety of methylphenidate and atomoxetine for attention deficit hyperactivity disorder: a systematic review

摘要:

目的：对中国儿童青少年注意缺陷多动障碍（ADHD）来说, 哌醋甲酯速释片（IR-MPH）、哌醋甲酯控释片（OROS-MPH）和托莫西汀（AHC）等3种药物的疗效、安全性等问题尚存在争议，本研究采用系统综述的方法评价三者治疗中国儿童青少年ADHD的疗效及安全性，为临床用药提供依据。方法：系统检索CNKI、中文科技期刊数据库、CBMDISC网络版、Pubmed、Embase 和 MEDLINE数据库中相关的随机或临床对照研究。由两名评价者独立筛选、摘录文献信息并对纳入文献进行质量评价。结果：共纳入8篇文献。IR-MPH、OROS-MPH和AHC三者对ADHD的疗效确切，OROS-MPH在改善同伴关系、CGI-I评分、母亲满意度、心身问题因子等方面优于IR-MPH。AHC组与IR-MPH组的疗效评分差异无统计学意义。三者不良反应发生率差异无统计学意义,均为轻度不良反应。结论：OROS-MPH可能优于IR-MPH, AHC与IR-MPH 疗效相当。三者的安全性相当,耐受性较好。

Abstract:

OBJECTIVE: To assess and compare the effectiveness and safety of methylphenidate immediate-release tablets (IR-MPH), methylphenidate controlled release tablets (OROS-MPH) and atomoxetine (AHC) for attention deficit hyperactivity disorder (ADHD) in Chinese children. METHODS: Randomized or clinical controlled trials on the effectiveness and safety of IR-MPH, OROS-MPH and AHC for ADHD were searched in electronic databases of CNKI, VIP, CBMDISC online, PubMed, Embase and MEDLINE. Two reviewers independently extracted the data and assessed the quality of the included literatures. RESULTS: Eight trials were finally included. IR-MPH, OROS-MPH and AHC were effective for ADHD. OROS-MPH was superior to IR-MPH in the improvement of peer relationship, CGI-I score, mother satisfaction and psychosomatic problems. There were no significant differences in the effectiveness between the AHC and IR-MPH groups. The adverse events related to the therapy with IR-MPH, OROS-MPH or AHC were mild and the incidence rates of adverse events were not significantly different among the three groups. CONCLUSIONS: The effectiveness of OROS-MPH for the treatment of ADHD is probably superior to IR-MPH, and the effectiveness between AHC and IR-MPH is similar. The three drugs demonstrate the safety and well tolerance.