A systematic review and economic model of the effectiveness and ...

Hyperactivity
Five trials (published in four papers) evaluated
hyperactivity/impulsivity using the ADHD Rating
Scale (Table 46). Three of these studies also used a
Conners’ scale to measure hyperactivity. 73,75,94 All
results were significantly in favour of ATX, except
when the CTRS was used in the study by
Michelson and colleagues. 75 The mean differences
for ADHD Rating Scale are presented for each of
the five studies in Figure 17.
TABLE 46 Results for hyperactivity [ATX high dose (≥ 1.5 mg/kg/day) versus placebo]
© Queen’s Printer and Controller of HMSO 2006. All rights reserved.
Health Technology Assessment 2006; Vol. 10: No. 23
Quality of life
Weiss and colleagues 94 presented results for CGI
Severity and Clinical Global Improvement. For both
measures, children in the ATX group had better
behaviour than children in the placebo group
(p < 0.001). Similar results were observed in the
study by Michelson and colleagues 73 (CGI ADHD
Severity: p < 0.05), Spencer and colleagues 89 (CGI
ADHD Severity: p = 0.003) and Michelson and
colleagues 75 (CGI Severity: p = 0.003).
Study Scale ATX high dose: Placebo: Mean
mean (SD) mean (SD) difference a
6–15 years
Michelson, 2004 75 Baseline/change from Baseline/change
baseline from baseline MD (95% CI)
ADHD-RS-IV
(hyperactive/impulsive)
7.2 (5.5)/3.1 (7.0) 7.1 (5.5)/5.9 (7.4) See Figure 17
CPRS (hyperactivity) 4.5 (3.8)/1.5 (4.7) 4.6 (4.2)/3.1 (4.9) –1.60 (–2.62 to –0.58)
CTRS (hyperactivity) 7.7 (5.1)/0.4 (5.2) 8.1 (5.5)/1.4 (4.6) –1.00 (–2.15 to 0.15)
7–13 years
Spencer, 2002 89 ADHD-RS
(hyperactive/impulsive)
19.3 (6.1)/–8.0 (7.4) 19.2 (5.5)/–2.5 (5.9) See Figure 17
Spencer, 2002 89 8–12 years
ADHD-RS
(hyperactive/impulsive)
16.8 (6.5)/–6.9 (6.6) 16.5 (6.1)/–2.9 (7.1) See Figure 17
Weiss, 2004 94 8–18 years
ADHD-RS-IV–Teacher: Inv:
(hyperactive/impulsive)
CPRS-R (hyperactivity) subscale
mean score (SD)
[Confidential information removed]
Michelson, 2001 73 ADHD-RS-IV
(hyperactive/impulsive)
17.6 (6.2)/–6.7 (7.5) 16.9 (6.6)/–3.2 (5.6) see Figure 17
CPRS-R (hyperactivity) 10.6 (4.6)/–4.3 (4.6) 10.3 (4.9)/–1.1 (3.9) –3.20 (–4.59 to –1.81)
a Note that owing to the overall poor reporting of study methodology, values should be interpreted with caution (with the
exception of Spencer and colleagues; 89 [Confidential information removed].
Lower scores represent a better behavioural outcome.
ADHD-RS-IV: Attention Deficit/Hyperactivity Disorder Rating Scale IV–Parent Version: investigator-administered and scored;
CPRS, Conners’ Parent Rating Scale; CTRS, Conners’ Teacher Rating Scale; CPRS-R, Conners’ Parent Rating Scale – Revised.
Study
Michelson 2001
Spencer 2002a
Spencer 2002b
Michelson 2004
Weiss 2004
FIGURE 17 Mean differences: ATX high dose versus placebo
ATX (high dose) Placebo
WMD (fixed)
WMD (fixed)
N Mean (SD) N Mean (SD) 95% CI
95% CI
82 –6.70 (7.50) 83 –3.20 (5.60)
–3.50 (–5.52 to –1.48)
64 –8.00 (7.40) 61 –2.50 (5.90)
–5.50 (–7.84 to –3.16)
63 –6.90 (6.60) 60 –2.90 (7.10)
–4.00 (–6.43 to –1.57)
290 3.10 (7.00) 123 5.90 (7.40)
–2.80 (–4.34 to –1.26)
[Confidential information removed]
–10 –5 0 5 10
Favours ATX Favours placebo
63