Serotonin and Noradrenaline Reuptake Inhibitors (SNRI) updated on 07-01-2025

ADHD (Attention deficit hyperactivity disorder): Diagnosis/Risk

R analysis
id Study   Lib. in paper Exposition period    Study type  Control type 
 
Tags OR 95%CI x1/n1 x0/n0 no cases no exposed ROB Ref.
S18387
R77531
Heuvelman - Venlafaxine, 2023 Attention deficit hyperactivity disorder -Medical codes or therapy records that indicated that the child had been prescribed ADHD medication - Mean age at end of follow-up 10.04 years, range 4–22 years during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: Yes Monotherapy: no or not specified Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy) 0.97 [0.48;1.96] -/818   -/16,330 - 818
ref
S18333
R77346
Suarez - SNRI (Controls unexposed, discontinuers), 2022 Attention Deficit Hyperactivity Disorder - ≥ 2 dates with ICD-9 Dx 314.xx or ≥ 2 dispensings or 1 diagnosis and 1 dispensing - At ≥ 2 years of age 2nd and/or 3rd trimester retrospective cohort (claims database) unexposed, sick Adjustment: Yes Monotherapy: no or not specified Unexposed sick: recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy) 0.80 [0.61;1.04] 256/8,540   171/4,899 427 8,540
ref
S18334
R77357
Suarez - SNRI (Controls unexposed, general pop), 2022 Attention Deficit Hyperactivity Disorder - ≥ 2 dates with ICD-9 Dx 314.xx or ≥ 2 dispensings or 1 diagnosis and 1 dispensing - At ≥ 2 years of age 2nd and/or 3rd trimester retrospective cohort (claims database) unexposed (general population or NOS) excluded Adjustment: Yes Monotherapy: no or not specified 1.07 [0.94;1.23]
excluded (control group)
258/8,659   51,087/2,910,114 51,345 8,659
ref
S12487
R47104
Yeh - SNRI, 2021 Attention-deficit/hyperactivity disorder (ADHD - at least twice outpatient visits within each year for ICD-9 code: 314) - At 0-10 years old during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: Yes Monotherapy: no or not specified Unexposed sick: old history of illness/treatment (> 12 months before pregnancy) or not specified 2.53 [1.26;5.06] -/56   -/5,243 - 56
ref
S11704
R46833
Boukhris - SNRI (Controls exposed to TCA) , 2017 Infants with attention deficit hyperactivity disorder (ADHD-ICD9: 314.0; 314.01; 314.9; ICD10:F90;F90.0;F90.1;F90.2; F90.8;F90.9 or ADHD medications) - Mean 6-7 years old (0-11 years) 2nd and/or 3rd trimester retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No Monotherapy: SNRI only 0.56 [0.28;1.11] C
excluded (control group)
18/445   16/227 34 445
ref
S11705
R46834
Boukhris - SNRI (Controls unexposed, NOS), 2017 Infants with attention deficit hyperactivity disorder (ADHD-ICD9: 314.0; 314.01; 314.9; ICD10:F90;F90.0;F90.1;F90.2; F90.8;F90.9 or ADHD medications) - Mean 6-7 years old (0-11 years) 2nd and/or 3rd trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: SNRI only 1.40 [0.80;2.50] 18/445   4,430/141,905 4,448 445
ref
S11706
R46835
Laugesen - SNRI, 2013 Attention deficit hyperactivity disorder ADHD (diagnosis of ADHD or a redemption of a prescription for ADHD medication) - Median 8 years old (1-14 years) during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: SNRI only 1.00 [0.40;2.50] -/763   -/816,792 - 763
ref
Total 5 studies 1.18 [0.77;1.81] 4,875 10,622
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

StudyTE95% CIn casesn exposedweightROBABCDEF Heuvelman - Venlafaxine, 2023Heuvelman - Venlafaxine, 2023 0.97[0.48; 1.96]-81818%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: criticalROB mesure: moderateROB reporting: low Suarez - SNRI (Controls unexposed, discontinuers), 2022Suarez - SNRI, 2022 1 0.80[0.61; 1.04]4278,54030%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Yeh - SNRI, 2021Yeh - SNRI, 2021 2.53[1.26; 5.06]-5618%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: unclearROB mesure: moderateROB reporting: critical Boukhris - SNRI (Controls unexposed, NOS), 2017Boukhris - SNRI, 2017 2 1.40[0.80; 2.50]4,44844521%ROB confusion: moderateROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Laugesen - SNRI, 2013Laugesen - SNRI, 2013 1.00[0.40; 2.50]-76313%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Total (5 studies) I2 = 63% 1.18[0.77; 1.81]4,87510,6220.210.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, discontinuers; 2: Controls unexposed, NOS;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.18[0.77; 1.81]4,87510,62263%NAHeuvelman - Venlafaxine, 2023 Suarez - SNRI (Controls unexposed, discontinuers), 2022 Yeh - SNRI, 2021 Boukhris - SNRI (Controls unexposed, NOS), 2017 Laugesen - SNRI, 2013 5 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.27[0.79; 2.07]4,4481,2080%NABoukhris - SNRI (Controls unexposed, NOS), 2017 Laugesen - SNRI, 2013 2 unexposed, sickunexposed, sick 1.19[0.61; 2.35]4279,41478%NAHeuvelman - Venlafaxine, 2023 Suarez - SNRI (Controls unexposed, discontinuers), 2022 Yeh - SNRI, 2021 3 Tags Adjustment   - Yes  - Yes 1.18[0.77; 1.81]4,87510,62263%NAHeuvelman - Venlafaxine, 2023 Suarez - SNRI (Controls unexposed, discontinuers), 2022 Yeh - SNRI, 2021 Boukhris - SNRI (Controls unexposed, NOS), 2017 Laugesen - SNRI, 2013 5 Monotherapy   - no or not specified  - no or not specified 1.19[0.61; 2.35]4279,41478%NAHeuvelman - Venlafaxine, 2023 Suarez - SNRI (Controls unexposed, discontinuers), 2022 Yeh - SNRI, 2021 3   - SNRI only  - SNRI only 1.27[0.79; 2.07]4,4481,2080%NABoukhris - SNRI (Controls unexposed, NOS), 2017 Laugesen - SNRI, 2013 2 Unexposed sick   - intermediate history of illness/tre ...  - intermediate history of illness/treatment (3-12 months before pregnancy) 0.97[0.48; 1.96]-818 -NAHeuvelman - Venlafaxine, 2023 1   - old history of illness/treatment (> ...  - old history of illness/treatment (> 12 months before pregnancy) or not specified 2.53[1.26; 5.07]-56 -NAYeh - SNRI, 2021 1   - recent illness/treatment (during o ...  - recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy) 0.80[0.61; 1.04]4278,540 -NASuarez - SNRI (Controls unexposed, discontinuers), 2022 1 All studiesAll studies 1.18[0.77; 1.81]4,87510,62263%NAHeuvelman - Venlafaxine, 2023 Suarez - SNRI (Controls unexposed, discontinuers), 2022 Yeh - SNRI, 2021 Boukhris - SNRI (Controls unexposed, NOS), 2017 Laugesen - SNRI, 2013 50.210.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-1.11.30.5610.000Heuvelman - Venlafaxine, 2023Suarez - SNRI (Controls unexposed, discontinuers), 2022Yeh - SNRI, 2021Boukhris - SNRI (Controls unexposed, NOS), 2017Laugesen - SNRI, 2013

Asymetry test p-value = 0.2084 (by Egger's regression)

slope=-0.4892 (0.3353); intercept=2.2233 (1.3916); t=1.5976; p=0.2084

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 11704, 18334

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.08[0.95; 1.23]55,7939,8670%NASuarez - SNRI (Controls unexposed, general pop), 2022 Boukhris - SNRI (Controls unexposed, NOS), 2017 Laugesen - SNRI, 2013 3 unexposed, sick controlsunexposed, sick controls 1.19[0.61; 2.35]4279,41478%NAHeuvelman - Venlafaxine, 2023 Suarez - SNRI (Controls unexposed, discontinuers), 2022 Yeh - SNRI, 2021 3 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.56[0.28; 1.11]34445 -NABoukhris - SNRI (Controls exposed to TCA) , 2017 10.510.01.0