A comparative study of methylphenidate and lisdexamphetamine in adult ADHD – a systematic literature review

Sammanfattning: Attention deficit hyperactivity disorder (ADHD) affects not only children as it was initially assumed but continues into adulthood in 50% of the cases. ADHD is a major cause of cognitive disability in children, increases risks for criminal behavior, unemployment and is generally associated with low quality of life. The treatment of ADHD is primarily with the so-called central stimulants, which increase norepinephrine and dopamine transmission in the brain. These medications are classed as narcotics, and currently there are no clinically available predictors of efficacy, so trial and error attempts are made until one finds optimal treatment. During the trial time, risk for additional suffering and adverse events increase. The main aim of the study was to compare methylphenidate (MPH) and lisdexamphetamine (LDX) in the treatment of adult ADHD. A second aim was to investigate predictors for treatment outcome that can be used for precision medicine. This study was a systematic review of the existing litterateur by searching two databases, PubMed and Cochrane Library. Inclusion criteria were adults with ADHD, treated with MPH or LDX for at least 6 weeks, in a randomized placebo-controlled design. The results indicate that both LDX and MPH are highly effective, with similar efficacy, but that LDX may be associated with less adverse events in adults and hence a better choice. Possible predictors of treatment response found were severity of illness, dosage of drug and level of education. These findings, including major weaknesses and limitations, will be discussed in what follows.