La prévalence administrative du trouble déficitaire de l’attention avec ou sans hyperactivité (TDAH) a connu une augmentation au cours des dernières années. De fait, la prescription des traitements du TDAH dont le méthylphénidate (MPH), traitement le plus largement prescrit, a augmenté. Dans ce contexte, l’évaluation des risques à long terme associés à son utilisation est d’une importance cruciale. Cet article a pour objectif de présenter les résultats des études sur l’utilisation du MPH à long terme. Nous avons réalisé une revue de la littérature des dix dernières années (20 mars 2014–20 mars 2024), en nous appuyant sur la base de données PubMed, afin d’évaluer ces risques. Les résultats de notre revue mettent en lumière certains aspects clés. Contrairement à certaines préoccupations initiales, la littérature suggère un effet potentiellement protecteur du MPH contre la dépression et les troubles liés à l’usage de substances. De plus, aucune augmentation significative du risque de suicide, de troubles psychotiques ou de dysfonctionnement testiculaire n’a été observée dans les études examinées. Des préoccupations subsistent concernant les effets cardiovasculaires à long terme. Des données récentes indiquent une augmentation du risque d’hypertension et de maladie artérielle chez les patients sous MPH, lors de prescriptions de doses élevées. Par ailleurs, aucun surrisque d’arythmie, de trouble ischémique ou thromboembolique n’était retrouvé. En outre, l’impact du MPH sur la croissance reste une question ouverte. Les études incluses dans notre revue présentent des résultats hétérogènes quant à son influence sur la croissance à moyen et long terme, avec un impact qui resterait faible en moyenne. Une compréhension approfondie des risques associés au traitement au MPH est essentielle pour informer correctement patients et familles afin de permettre une décision partagée et informée quant à l’instauration et à la poursuite de ce traitement dans le cadre du TDAH.

The increasing administrative prevalence of Attention-Deficit Hyperactivity Disorder (ADHD) over recent years has correspondingly escalated the prescriptions of pharmacological treatments for ADHD, particularly methylphenidate (MPH), which remains the most extensively prescribed medication for this condition. In light of this trend, evaluating the long-term risks associated with using MPH is important. This article aims to present findings from studies concerning the long-term use of MPH, derived from a literature review of the past decade, primarily focusing on data sourced from PubMed to assess these risks. Our review has drawn on a diverse range of studies, including cohort studies, meta-analyses, and database reviews from various global regions, reflecting a comprehensive international perspective on the long-term safety of MPH. Our review highlights several key aspects. Initial worries about the adverse psychiatric effects of MPH did not find strong support in subsequent studies. Rather, the current body of literature suggests that MPH may have a protective effect against depression and substance use disorders. We found no significant increase in the likelihood of suicide or psychotic disorders among long-term users of MPH. In fact, studies indicate that MPH treatment might reduce the incidence of depression. Moreover, contrary to concerns that stimulant treatment might predispose individuals to SUDs, recent longitudinal studies have generally shown no increased risk of substance misuse. Some studies have even suggested a lower incidence of substance misuse among patients treated with MPH. The review also delved into cardiovascular risks, which have been a notable concern with long-term MPH usage. While short-term studies typically showed minimal cardiovascular risks, results on longer-term effects suggest potential increases in hypertension and other arterial diseases for a higher dosage, highlighting the necessity for careful cardiovascular monitoring in patients undergoing long-term treatment. No elevated risk was described concerning other cardiovascular diseases. Results regarding the impact on growth have been mixed. Some studies suggest a temporary reduction in growth velocity that normalizes over time. This pattern suggests a delayed, rather than permanently stunted, growth trajectory in children treated with MPH over the long term. Lastly, our review did not find any risk of testicular dysfunction in patients treated with MPH. The collective findings from the reviewed studies offer reassurance regarding several of the initial concerns about the long-term use of MPH. While there are concerns about potential hypertension and arterial disease risks and uncertainties regarding growth, it is important to regularly monitoring for patients using MPH. These findings should be communicated transparently to patients and their families, helping to inform shared decision-making about the initiation and continuation of MPH therapy for ADHD. As research continues to evolve, it is imperative to keep updating our understanding of the safety of MPH safety profile to optimize treatment strategies and ensure that patients receive the most effective and safe care possible.