A recent Cochrane review assessed the efficacy of methylphenidate for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Notwithstanding the moderate-to-large effect sizes for ADHD symptom reduction found in the meta-analysis, the authors concluded that the quality of the evidence is low and therefore the true magnitude of these effects remains uncertain. We identified a number of major concerns with the review, in the domains of study inclusion, approaches to quality assessment and interpretation of data relating to serious adverse events as well as of the clinical implications of the reported effects. We also found errors in the extraction of data used to estimate the effect size of the primary outcome. Considering all the shortcomings, the conclusion in the Cochrane review that the status of the evidence is uncertain is misplaced. Professionals, parents and patients should refer to previous reviews and existing guidelines, which include methylphenidate as one of the safe and efficacious treatment strategies for ADHD.
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Competing interests TB served in an advisory or consultancy role for Actelion, Hexal Pharma, Lilly, Medice, Novartis, Oxford outcomes, Otsuka, PCM scientific, Shire and Viforpharma. He received conference support or speaker's fee from Medice, Novartis and Shire. He is/has been involved in clinical trials conducted by Shire and Viforpharma. He received royalties from Hogrefe, Kohlhammer, CIP Medien and Oxford University Press. JB has, in the past 3 years, been a consultant to/member of the advisory board of/and/or speaker for Janssen Cilag BV, Eli-Lilly, Lundbeck, Shire, Roche, Medice, Novartis and Servier. He has received research support from Roche and Vifor. He is not an employee nor stock shareholder of any of these companies. He has no other financial or material support, including expert testimony, patents, royalties. DC reports grants and personal fees from Shire, personal fees from Eli-Lilly, grants from Vifor, personal fees from Novartis and personal fees from Oxford University Press. SC: Since January 2016 onwards, SC has received reimbursement for travel and accommodation expenses from the Association for Child and Adolescent Central Health (ACAMH), a non-profit organisation, in relation to lectures that he delivered for ACAMH. He declares the absence of any financial conflicts of interest.ICKW receives grants from the European Union FP7 programme during the conduct of the study; grants from Shire, grants from Janssen-Cilag, grants from Eli-Lilly and grants from Pfizer, outside the submitted work; he ICKW is a member of the National Institute for Health and Clinical Excellence (NICE) ADHD Guideline Group and acted as an advisor to Shire.
Provenance and peer review Not commissioned; externally peer reviewed.