A systematic review of randomized controlled trials of bupropion versus methylphenidate in the treatment of attention-deficit/hyperactivity disorder

Figures & data

Figure 1 Flow diagram of study design.

Abbreviation: EU-CTR, EU Clinical Trials Register.

Table 1 The basic characteristics of randomized controlled trials for bupropion versus methylphenidate in ADHD

Study (author, year)	Number of randomized patients	Age of subjects (years)	Study duration (weeks)	Drug/dose	Diagnostic criteria	Response criteria	Outcome measures
Barrickman et al 1995^Citation19	18	7–17	16	Bupropion 50–200 mg/day Methylphenidate 20–60 mg/day	DSM-III-R	N/A	ICQ, CGI-S, CGI-I, CPT, AVLT
Kuperman et al 2001^Citation20	19	18–60	8	Bupropion up to 300 mg/day Methylphenidate up to 0.9 mg/kg/day	DSM-IV	CGI-I score =1 or 2	CGI-S, CGI-I, ADHD-RS-Self, HVLT, Digit Ordering Test, Trails A and B, verbal fluency, CPT
Levin et al 2006^Citation21	65	18–60	12	Bupropion 200–400 mg/day Methylphenidate 40–80 mg/day	DSM-IV	≥30% reduction in AARS	AARS, CGI-I, WRAADDS
Jafarinia et al 2012^Citation22	44	6–17	6	Bupropion up to 100 mg/day for <30 kg and up to 150 mg/day for >30 kg Methylphenidate up to 20 mg/day for <30 kg and up to 30 mg/day for >30 kg	DSM-IV-TR	≥50% reduction in ADHD-RS-IV	Teacher and parent ADHD-RS-IV

Abbreviations: AARS, Adult ADHD Rating Scale; ADHD, attention-deficit/hyperactivity disorder; ADHD-RS, ADHD Rating Scale; AVLT, Rey Auditory Verbal Learning Test; CGI-I, Clinical Global Impression – Improvement Scale; CGI-S, Clinical Global Impression – Severity of Illness; CPT, Conners Continuous Performance Test; DSM, Diagnostic and Statistical Manual of Mental Disorders; HVLT, Hopkins Verbal Learning Test; ICQ, Iowa–Conner Abbreviated Parent and Teacher Questionnaire; N/A, not applicable; WRAADDS, Wender–Reimherr Adult Attention Deficit Disorder Scale.

Table 2 Risk of bias summary of controlled trials of bupropion versus methylphenidate in attention-deficit/hyperactivity disorder

Study (author, year)	Issues of bias
	1	2	3	4	5	6	7
Barrickman et al 1995^Citation19	U	L	L	U	U	L	L
Kuperman et al 2001^Citation20	U	U	U	L	U	L	L
Levin et al 2006^Citation21	U	U	L	L	U	L	L
Jafarinia et al 2012^Citation22	L	L	L	L	U	L	L

Notes: 1, adequate sequence generation; 2, allocation concealment; 3, blinding (subjective outcome); 4, dropout data addressed; 5, free of selective reporting; 6, free of other bias; 7, baseline similarity.

Abbreviations: L, low risk of bias; U, unclear.

Figure 2 Comparison of the mean changes from baseline of ADHD rating scales for parents of children and adolescents with ADHD: bupropion versus methylphenidate.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; CI, confidence interval; df, degrees of freedom; IV, inverse variance; SD, standard deviation; Std, standard.

Figure 3 Comparison of the mean changes from baseline of ADHD rating scales for teachers of children and adolescents with ADHD: bupropion versus methylphenidate.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; CI, confidence interval; df, degrees of freedom; IV, inverse variance; SD, standard deviation; Std, standard.

Figure 4 Comparison of the mean changes from baseline of ADHD rating scales in adult ADHD: bupropion versus methylphenidate.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; CI, confidence interval; df, degrees of freedom; IV, inverse variance; SD, standard deviation; Std, standard.

Figure 5 Comparison of relative risk for clinical response rates in ADHD: bupropion versus methylphenidate.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; CI, confidence interval; df, degrees of freedom; M–H, Mantel–Haenszel.

Figure 6 Comparison of relative risk for an overall discontinuation rate in ADHD: bupropion versus methylphenidate.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; CI, confidence interval; df, degrees of freedom; M–H, Mantel–Haenszel.

Figure 7 Comparison of relative risk for a discontinuation rate due to adverse events in ADHD: bupropion versus methylphenidate.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; CI, confidence interval; df, degrees of freedom; M–H, Mantel–Haenszel.

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