FARMACOTERAPIA DO TRANSTORNO DO DÉFICIT DE ATENÇÃO/HIPERATIVIDADE EM ADULTOS: REVISÃO SISTEMÁTICA COM METANÁLISE DE ENSAIOS CLÍNICOS RANDOMIZADOS (2015-2025)
DOI:
https://doi.org/10.56238/levv17n60-025Palavras-chave:
TDAH, Adultos, Metilfenidato, Lisdexanfetamina, Atomoxetina, Guanfacina, Metanálise, Ensaio Clínico RandomizadoResumo
Introdução: O transtorno do déficit de atenção/hiperatividade (TDAH) afeta aproximadamente 2,5% da população adulta globalmente. Múltiplos agentes farmacológicos estão disponíveis, porém dados comparativos de eficácia e segurança permanecem limitados. Objetivo: Revisar sistematicamente e realizar metanálise da eficácia, segurança e tolerabilidade de tratamentos farmacológicos para TDAH em adultos utilizando ensaios clínicos randomizados (ECR) publicados entre 2015 e 2025. Métodos: Buscas sistemáticas foram conduzidas em PubMed/MEDLINE, Embase e Cochrane Library para ECR duplo-cegos, controlados por placebo, em adultos (≥18 anos) com TDAH diagnosticado conforme DSM-IV, DSM-5 ou CID-10/11. Desfecho primário foi redução de sintomas medida por escalas validadas (ADHD-RS, Conners, SNAP-IV). Desfechos secundários incluíram eventos adversos, taxas de descontinuação e melhora funcional. Risco de viés foi avaliado usando Cochrane RoB 2.0. Metanálise utilizou modelos de efeitos aleatórios com diferenças de médias padronizadas (DMP) e intervalos de confiança 95% (IC 95%). Heterogeneidade foi avaliada usando estatística I². Metodologia GRADE foi aplicada para avaliar qualidade de evidência. Resultados: Trinta e sete ECR (n=2.289 adultos) foram incluídos. Metilfenidato de liberação prolongada demonstrou o maior tamanho de efeito (DMP: −0,92; IC 95%: −1,08 a −0,76), seguido por lisdexanfetamina (DMP: −0,96; IC 95%: −1,17 a −0,76), sais de anfetamina mista (DMP: −0,81; IC 95%: −0,95 a −0,67) e atomoxetina (DMP: −0,48; IC 95%: −0,64 a −0,33). Guanfacina mostrou eficácia moderada (DMP: −0,66; IC 95%: −0,94 a −0,38). Estimulantes demonstraram aceitabilidade superior comparado a não-estimulantes. Eventos adversos foram geralmente leves e dose-dependentes. Heterogeneidade foi moderada (I²: 30–50%). Conclusão: Medicações estimulantes, particularmente metilfenidato e lisdexanfetamina, representam tratamentos farmacológicos de primeira linha para TDAH em adultos, com grandes tamanhos de efeito e perfis de tolerabilidade favoráveis. Não-estimulantes oferecem alternativas para pacientes com contraindicações ou comorbidades. Qualidade de evidência varia de moderada a alta para estimulantes e baixa a moderada para não-estimulantes.
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