Guanfacine for attention deficit and hyperactivity disorder in pediatrics: A systematic review and meta-analysis

Simona Ruggiero, Antonio Clavenna, Laura Reale, Annalisa Capuano, Francesco Rossi, Maurizio Bonati

Research output: Contribution to journalArticlepeer-review


To review the evidence from randomized controlled trials (RCTs) on the safety and efficacy of guanfacine in pediatric attention deficit hyperactivity disorder (ADHD), a bibliographic search up to May 2014 was performed using the Cochrane Library[U+05F3]s Central Register of Controlled Trials, the Embase, PsycINFO, and Medline databases, and clinical trials registers. The search terms used were: ["guanfacine"] and ["child" or "adolescent" or "pediatrics"] and ["randomized controlled trial"] and ["Attention Deficit Disorder with Hyperactivity" or "Attention Deficit Disorder" or "Attention Hyperactivity Disorder" or "Hyperactivity" or "ADHD"]. A meta-analysis was performed using response, defined as a score≤2 on the Clinical Global Impression Improvement score, as the outcome measure. In all, 7 out of 48 studies were included, for a total of 1752 participants. All studies compared guanfacine versus placebo, with a duration ranging from 6 to 16 weeks. In all, the Clinical Global Impression Improvement score was reported as a secondary measure. Overall, 694/1177 (59.0%) participants in the guanfacine group benefited from the treatment compared to 192/575 (33.3%) in the placebo group (pooled OR 3.2; 95%CI 2.4-4.1). The participants with at least one adverse event were 948 (82.4%) in the guanfacine and 376 (67.9%) in the placebo group (OR 2.6; 95%CI 1.6-4.4). Somnolence (OR 4.9), sedation (OR 2.8), and fatigue (OR 2.2), were the adverse events with the greatest risk of occurrence in the guanfacine versus the placebo group. On the basis of seven randomized, placebo controlled trials guanfacine resulted safe and effective in treating children and adolescents with ADHD.

Original languageEnglish
Pages (from-to)1578-1590
Number of pages13
JournalEuropean Neuropsychopharmacology
Issue number10
Publication statusPublished - Oct 1 2014


  • Attention deficit disorder with hyperactivity
  • Child
  • Guanfacine
  • Meta-analysis
  • Systematic review

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Pharmacology (medical)
  • Biological Psychiatry
  • Neurology
  • Pharmacology


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