Nine RCTs were included in the review (2,762 participants, range 25 to 1,323), five double-blinded and four open-label. All scored at least 12 points on the Detsky scale.
There was no significant difference between methylphenidate and atomoxetine in ADHD Rating Scale scores (SMD 0.09, 95% CI -0.08 to 0.26; nine RCTs), response rates (RR 0.93, 95% CI 0.76 to 1.14; eight RCTs), or all-cause discontinuation (RR 1.22, 95% CI 0.87 to 1.71; seven RCTs). There was significant heterogeneity (p=0.002, Ι²=67%) for the primary outcome which was attributed to differences between the open-label studies.
In subgroup analysis of ADHD Rating Scale scores there was a significant benefit from osmotically-released methylphenidate compared to atomoxetine (SMD 0.32, 95% CI 0.12 to 0.53). The findings of other subgroup analyses did not differ substantially from the main findings.