Takaisin

Guanfacine 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: C

Treatment with guanfacine may 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 guanfacine on oppositional symptoms was evaluated.

The researchers found 2 RCT-studies of guanfacine (alpha 2-agonist) extended release including 678 children with ADHD (comorbid ODD diagnosis was allowed, but the rate of comorbidity was not specified). One study evaluated guanfacine for 9 weeks as an adjunct to psychostimulants; the other study guanfacine monotherapy for 8 weeks in 6–12-year olds with oppositional behaviour as primary outcome.

Both studies provided adequate data on change scores to be included in the meta-analysis. The SMD between guanfacine extended release and placebo for oppositional behavior was 0.43 (95% CI 0.18–0.68; I2= 5.4%, Z= 3.38, p<0.001)

The authors rated the 2 studies into class II (quality range I-III). They found minor limitations in study quality, no inconsistency, no indirectiness, no serious imprecision. They noted a possible publication bias. Dose-response effect was not demonstrated.

  • Study quality: Moderate
  • Accessability: Moderate, guanfacine rather seldom used in Finland for ADHD, though the use is increasing
  • Comment: Concerning guanfacine, given information on subjects and methods was limited.

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