Takaisin

Atomoxetine for oppositional behaviour in youth with ADHD with and without ODD/CD

Evidence Summaries for Current Care Guidelines
Eeva Aronen
12.12.2018

Level of evidence: B

Treatment with atomoxetine seems to slightly decrease oppositional behaviour in youth with ADHD with and without ODD/CD in the short term.

In a systematic review and meta-analysis «Pringsheim T, Hirsch L, Gardner D ym. The pharmaco...»1 of the pharmacological management of oppositional behaviour, conduct problems, and aggression in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder the effects of atomoxetine on oppositional symptoms were evaluated.

One systematic review and meta-analysis «Schwartz S, Correll CU. Efficacy and safety of ato...»2 of atomoxetine effects on oppositional defiant disorder symptoms (ODD symptoms) as a secondary outcome measure was found. In that study, all published and unpublished data on atomoxetine from placebo-controlled, double-blind, randomized studies in children and adolescents with ADHD and average intelligence were included, all together 25 studies, with the total of 3928 youth. Mean age was 10.3 years, with 68.2% being <13 years old. 23 of the 25 studies were industry funded, mean trial duration was 8,6 weeks (range 4–18 weeks), mean atomoxetine dose was 1.17mg/kg/day. Comorbid ODD and/or Conduct disorder (CD) was present in 44.6% of the study subjects.

The results of the ODD outcomes (rating scales; SNAP-4 ODD, CPRS R: S Oppositional, ADHD symptom checklist -4 oppositional defiant-ADHD-SC4) were based on 15 comparisons involving 1907 patients (RCT-studies). The overall effect size for ODD symptoms was 0.33 (95% CI 0.24-0.43; I2=0%, p<0.001). The proportion of subjects with a ODD diagnosis did not significantly influence the effect size for ODD symptoms.

In the next step, the authors of the systematic review and meta-analysis «Pringsheim T, Hirsch L, Gardner D ym. The pharmaco...»1 of pharmacological management made their own review of methodological quality of the included 15 studies. They rated 4 studies into class I (highest quality), 5 studies class II, 2 studies class III. Dose-response effect was not demonstrated.

  • Study quality: moderate
  • Accessability: good
  • Comment: Effect size rather small, diagnosis of ODD did not significantly moderate the effect size for ODD symptoms, almost all studies industry-funded

References

  1. Pringsheim T, Hirsch L, Gardner D ym. The pharmacological management of oppositional behaviour, conduct problems, and aggression in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder: a systematic review and meta-analysis. Part 1: psychostimulants, alpha-2 agonists, and atomoxetine. Can J Psychiatry 2015;60:42-51 «PMID: 25886655»PubMed
  2. Schwartz S, Correll CU. Efficacy and safety of atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder: results from a comprehensive meta-analysis and metaregression. J Am Acad Child Adolesc Psychiatry 2014;53:174-87 «PMID: 24472252»PubMed