Long term methylphenidate exposure and growth in children and adolescents with ADHD. A systematic review and meta-analysis. (January 2021)

• Record Type: Journal Article
• Authors: Carucci, Sara; Balia, Carla; Gagliano, Antonella; Lampis, Angelico; Buitelaar, Jan K.; Danckaerts, Marina; Dittmann, Ralf W.; Garas, Peter; Hollis, Chris; Inglis, Sarah; Konrad, Kerstin; Kovshoff, Hanna; Liddle, Elizabeth B.; McCarthy, Suzanne; Nagy, Peter; Panei, Pietro; Romaniello, Roberta; Usala, Tatiana; Wong, Ian C.K.; Banaschewski, Tobias; Sonuga-Barke, Edmund; Coghill, David; Zuddas, Alessandro
• Is Part Of: Neuroscience and biobehavioral reviews. Volume 120(2021)
• Page Start: 509
• Page End: 525
• Publication Date: 2021-01
• Subjects: Attention deficit/hyperactivity disorder (ADHD) -- methylphenidate -- stimulants -- height -- weight -- growth -- puberty; Psychophysiology -- Periodicals; Human behavior -- Periodicals; Animal behavior -- Periodicals; Neurology -- Periodicals; Behavior -- Periodicals; Ethology -- Periodicals; Neurology -- Periodicals; Psychophysiologie -- Périodiques; Comportement humain -- Périodiques; Animaux -- Mœurs et comportement -- Périodiques; Neurologie -- Périodiques; Animal behavior; Human behavior; Neurology; Psychophysiology; Periodicals; Electronic journals; 573.8
• DOI: 10.1016/j.neubiorev.2020.09.031
• Languages: English
• ISSNs: 0149-7634

Abstract

Highlights: MPH is a very effective treatment for ADHD but there are concerns about potential adverse effects of extended treatment on several systems, including growth. Long term MPH appears to be associated with a statistically significant impact on height and weight in ADHD children and adolescents, but effect sizes are small, with possible minimal clinical effect. Sensitivity analysis did not reveal a significant effect of dose, age and drug naïvity condition as possible clinical moderators. Data on effect on pubertal maturation, although limited, seem to favour the exclusion of a possible drug effect on sexual maturation in ADHD subjects. Current clinical practice guidelines indicate the need of a careful assessment of growth parameters before starting stimulant treatment and the periodic monitoring using standardised growth charts. Particular caution should be taken in pre-school children. Abstract: Background: Methylphenidate (MPH) is an efficacious treatment for ADHD but concerns have been raised about potential adverse effects of extended treatment on growth. Objectives: To systematically review the literature, up to December 2018, conducting a meta-analysis of association of long-term (> six months) MPH exposure with height, weight and timing of puberty. Results: Eighteen studies (ADHD n = 4868) were included in the meta-analysis. MPH was associated with consistent statistically significant pre-post difference for both height (SMD = 0.27, 95% CI 0.16-0.38, p < 0.0001) and weight (SMD = 0.33, 95% CI 0.22-0.44, p < 0.0001) Z scores, with prominent impact on weight during the first 12 months and on height within the first 24-30 months. No significant effects of dose, formulation, age and drug-naïve condition as clinical moderators were found. Data on timing of puberty are currently limited. Conclusions: Long-term treatment with MPH can result in reduction in height and weight. However, effect sizes are small with possible minimal clinical impact. Long-term prospective studies may help to clarify the underlying biological drivers and specific mediators and moderators.