Pharmacological interventions for ADHD: a systematic review and dose–effect network meta-analysis

作者：Mikaïl Nourredine, Lucie Jurek, Tasnim Hamza, Andrea Cipriani, Fabien Subtil, Valeria Parlatini, Luís C. Farhat, Guilherme Fusetto Veronesi, Orestis Efthimiou, Georgia Salanti, Samuele Cortese · 发表于：The Lancet Psychiatry · 年份：2026 · DOI：10.1016/s2215-0366(26)00091-x · 被引用次数：1 · 研究领域：Attention Deficit Hyperactivity Disorder、Neuroethics, Human Enhancement, Biomedical Innovations、Autism Spectrum Disorder Research

BACKGROUND: Optimising the dosage of pharmacological treatments for ADHD is key to maximising their benefits, yet most clinical guidelines provide only limited information on this issue. Dose-effect relationships have not been comprehensively assessed across all ADHD medications and age groups, despite growing concerns about subtherapeutic prescribing. We aimed to estimate dose-effect curves for efficacy and tolerability of ADHD medications (stimulants and non-stimulants) across age groups. METHODS: We conducted a systematic review and dose-effect network meta-analysis of double-blind randomised controlled trials (RCTs) evaluating oral monotherapy (stimulants and non-stimulants) in individuals aged 5 years and older meeting standardised ADHD criteria. Studies involving genetic syndromes, treatment-resistant populations, or withdrawal-phase designs were excluded. We retrieved eligible studies from the MED-ADHD database, updated on Feb 17, 2025, without language restrictions. We included published and unpublished aggregated-level data. The primary outcome was efficacy (measured using validated clinical scales) and the secondary outcome was tolerability (discontinuation due to adverse events). Within-study bias was assessed with the Cochrane Risk of Bias Tool (version 2). We summarised dose-effect associations using a hierarchical Bayesian model with restricted cubic splines. Separate analyses were conducted for children or adolescents (aged <18 years) and adults (aged ≥18 years...