Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-25T00:02:26.885Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment adherence and persistence in adult ADHD: Results from a twenty-four week controlled clinical trial with extended release methylphenidate

Published online by Cambridge University Press:  15 April 2020

E. Sobanski ,
W. Retz ,
R. Fischer ,
C. Ose ,
B. Alm ,
O. Hennig  and
M. Rösler
E. Sobanski*
Affiliation:
Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, University of Heidelberg, J 5, 68159Mannheim, Germany
W. Retz
Affiliation:
Neurocentre, University Hospital of the Saarland, 66421Homburg/Saar, Germany
R. Fischer
Affiliation:
Medice Arzneimittel Pütter GmbH & Co KG, Kuhloweg 37, 58638Iserlohn, Germany
C. Ose
Affiliation:
Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine of University Hospital, University Duisburg-Essen, Hufelandstr. 55, 45122Essen, Germany
B. Alm
Affiliation:
Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, University of Heidelberg, J 5, 68159Mannheim, Germany
O. Hennig
Affiliation:
Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, University of Heidelberg, J 5, 68159Mannheim, Germany
M. Rösler
Affiliation:
Neurocentre, University Hospital of the Saarland, 66421Homburg/Saar, Germany
*
*Corresponding author. Tel.: +49 621 170 328 52; fax: +49 621 170 328 55. E-mail address:esther.sobanski@zi-mannheim.de (E. Sobanski).
Get access

Abstract

Purpose:

The aim of this analysis is to describe medication adherence, and treatment persistence, in adults with attention deficit/hyperactivity disorder (ADHD) treated for 24 weeks with extended release methylphenidate (MPH-ER). Additionally, patient-, disorder- and treatment-related factors associated with adherence and persistence will be identified.

Method:

Post-hoc analysis of the active treatment group of a placebo-controlled, randomised, 24 week trial with MPH-ER with univariate description and multiple logistic regression models and Hosmer and Lemeshow tests.

Results:

In the sample of 241 adults with ADHD (mean age of 35.2 ± 10.1 years), 9.4% of the patients were non-adherent, taking less than 80% of the dispensed medication. Factors associated with non-adherence included age < 25 years, education level lower than secondary education, lacking family history of ADHD, lower ADHD baseline severity and lower self- and observer-rated medication efficacy. Lacking family history of ADHD, lower education level and lower self-rated medication efficacy, predicted non-adherence with a prediction accuracy of 16%. Seventeen percent of the patients discontinued early with most discontinuing within the first five weeks of the MPH-ER titration phase. Mean persistence in the discontinuing group was 63.4 ± 49.4 days. Factors associated with discontinuation included male gender, lower education level, lacking family history of ADHD and lower self- and observer-rated medication efficacy. Treatment non-response, male gender and lower education level predicted treatment discontinuation with a prediction accuracy of 22.7%.

Conclusion:

Male adults without relatives with ADHD, with lower educational level and lower self- and observer-rated medication efficacy, who are newly treated with MPH-ER, are at increased risk of non-adherence and treatment discontinuation. Patients are at increased risk of treatment discontinuation during the medication titration phase.

Keywords

ADHDAdultsAdherencePersistenceMethylphenidate
Type
Original articles
Information
European Psychiatry , Volume 29 , Issue 5 , June 2014 , pp. 324 - 330
Copyright
Copyright © Elsevier Masson SAS 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adler, L.D., Nierenberg, A.A.Review of medication adherence in children and adults with ADHD. Postgrad Med 2010;122:184–191.CrossRefGoogle ScholarPubMed
American Psychiatric Association, Diagnostic and statistical manual of mental disorders. 4th text revisionDC: Washington; 2000.Google Scholar
Arbeitgemeinschaft für Methodik und Dokumentation in der Psychiatrie. Das AMDP-System. 8. überarbeitete Auflage. Goettingen, Hogrefe; 2006.Google Scholar
Bejerot, S., Ryden, E.M., Airlinde, C.M.Two-year outcome of treatment with central stimulant medication in adult attention deficit-/hyperactivity disorder: a prospective study. J Clin Psychiatry 2010;71:1590–1597.CrossRefGoogle ScholarPubMed
Burkhart, P., Dunbar-Jacob, J.Adherence research in the pediatric and adolescent populations: a decade in review. In: Hayman, L.Mahom, M.Turner, R.Chronic illness in children: an evidence-based approach New York: Springer; 2002. p. 199–229.Google Scholar
Busby, K.K., Sajatovic, M.Patient, treatment, and systems-level factors in bipolar disorder nonadherence: A summary of the literature. CNS Neurosci Ther 2010;16:308–315.CrossRefGoogle ScholarPubMed
CADDRA: Canadian, A.D.H.D. Practice Guidelines. Toronto: Canadian Attention Deficit Hyperactivity Disorder Resource Alliance 2008.Google Scholar
Caisley, H., Mueller, U.Adherence to medication in adults with attention deficit hyperactivity disorder and pro re nata dosing of psychostimulants: a systematic review. Eur Psychiatry 2012;27:343–349.CrossRefGoogle ScholarPubMed
Cantrell, C.R., Eaddy, M.T., Shah, M.B., Regan, T.S., Sokol, M.C.Methods for evaluating patient adherence to antidepressant therapy: a real-world comparison of adherence and economic outcomes. Med Care 2006;44:300–303.CrossRefGoogle ScholarPubMed
Christensen, L., Sasane, R., Hodgkins, P., Harley, C., Tetali, S.Pharmacological treatment patterns among patients with attention-deficit/hyperactivity disorder: retrospective claims-based analysis of a managed care population. Curr Med Res Opin 2010;26:977–989.CrossRefGoogle ScholarPubMed
Christiansen, H., Kis, B., Hirsch, O., Matthies, S., Hebebrand, J., Uekermann, J.et al.German validation of the Conners Adult ADHD Rating Scales (CAARS) II: Reliability, validity, diagnostic sensitivity and specificity. Eur Psychiatry 2011;27:321–328.CrossRefGoogle Scholar
Cramer, J.A., Roy, A., Burrell, A.et al.Medication compliance and persistence: terminology and definitions. Value Health 2008;11:44–47.CrossRefGoogle ScholarPubMed
Darredeau, C., Barrett, S.P., Jardin, B., Pihl, R.O.Patterns and predictors of medication compliance, diversion, and misuse in adult prescribed methylphenidate users. Hum Psychopharmacol Clin Exp 2007;22:529–536.CrossRefGoogle ScholarPubMed
Derogatis, L.R.SCL-90-R, administration, scoring & procedures. Manual for the revised version. Baltimore, MD: Johns Hopkins University; 1977.Google Scholar
Guy, W., Ban, T.A.The AMDP system. A manual for the assessment and documentation in psychopathology. Berlin: Springer; 1982.CrossRefGoogle Scholar
Haynes, R.B.Determinants of compliance: The disease and the mechanics of treatment. Baltimore MD: Johns Hopkins University Press; 1979.Google Scholar
Haynes, R.B., Ackloo, E., Sahota, N., McDonald, H.P., Yao, X.Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008 2.Google ScholarPubMed
Hodgkins, P., Sasane, R., Christensen, L., Harley, C., Liu, F.Treatment outcomes with methylphenidate formulations among patients with ADHD: retrospective claims analysis of a managed care population. Curr Med Res Opin 2001;27:53–62.CrossRefGoogle Scholar
Kooij, J.J.S., Bejerot, S., Blackwell, A., Caci, H., Casas-Brugue, M., Carpentier, P.J.et al.European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 2010;10:67.CrossRefGoogle ScholarPubMed
Kooij, J.J.S., Roesler, M., Philipsen, A., Wächter, S., Dejonckheere, J., van der Kolk, A.et al.Predictors and impact of non-adherence in adults with attention-deficit/hyperactivity disorder receiving OROS methylphenidate: results from a randomized, placebo-controlled trial. BMC Psychiatry 2013;13:36.CrossRefGoogle ScholarPubMed
Lawson, K.A., Johnsrud, M., Hodgkins, P., Sasané, R., Crismon, M.L.Utilization patterns of stimulants in ADHD in the Medicaid population: A retrospective analysis of data from the Texas Medicaid Program. Clin Ther 2012;34:944–956.CrossRefGoogle ScholarPubMed
Lehrl, S.Mehrfachwahl-Wortschatz-Intelligenztest: Form B. Erlangen. Germany: Straube; 1997.Google Scholar
Matheson, L., Asherson, P., Wong, I.C.K., Hodkins, P., Setyawan, J., Sasane, R.et al.patient experiences of impairment, service provision and clinical management in England: a qualitative study. BMC Health Serv Res 2013;13:184–197.CrossRefGoogle ScholarPubMed
National Institute for Health Clinical Excellence Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults. NICE clinical guideline 72. 2008 [full guideline: www.nice.org.uk/CG072].Google Scholar
Olfson, M., Marcus, S.C., Zhang, H.F., Wan, G.J.Continuity in methylphenidate treatment of adults with attention-deficit/hyperactivity disorder. J Manag Care Pharm 2007;13:570–577.Google ScholarPubMed
Perwien, A.R., Hall, J., Swensen, A., Swindle, R.Stimulant treatment patterns and compliance in children and adults with newly treated attention-deficit/hyperactivity disorder. J Manag Care Pharm 2004;10:122–129.Google ScholarPubMed
Ramos-Quiroga, J.A., Bosch, R., Castells, X., Valero, S., Nogueira, M., Yelmo, et al.Effect of switching drug formulations from immediate-release to extended-release OROS methylphenidate. A chart review of Spanish adults with attention-deficit hyperactivity disorder. CNS Drugs 2008;22:603–611.CrossRefGoogle ScholarPubMed
Rand, C.S.Measuring adherence with therapy for chronic diseases: implications for the treatment of heterozygous familial hypercholesterolemia. Am J Cardiol 1995;72(10):68D–74D.CrossRefGoogle Scholar
Retz-Junginger, P., Retz, W., Blocher, D., Weijers, H.G., Trott, G.E., Wender, P.H.et al.Wender Utah rating scale. The short-version for the assessment of the attention-deficit hyperactivity disorder in adults. Nervenarzt 2002;73:830–838.CrossRefGoogle ScholarPubMed
Roesler, M., Retz, W., Retz-Junginger, P., Thome, J., Supprian, T., Nissen, T.et al.Tools for the diagnosis of attention-deficit/hyperactivity disorder in adults. Self-rating behaviour questionnaire and diagnostic checklist. Nervenarzt 2004;75:888–895.Google Scholar
Roesler, M., Retz, W., Retz-Junginger, P., Stieglitz, R.D., Reimherr, F., Wender, P.Homburger ADHS Skalen für Erwachsene (HASE). Hogrefe: Goettingen; 2008.Google Scholar
Roesler, M., Fischer, R., Ammer, R., Ose, C., Retz, W.on behalf of the study group. A randomised, placebo-controlled, 24-week, study of low-dose extended-release methylphenidate in adults with attention-deficit/hyperactivity disorder. Eur Arch Psychiatry Clin Neurosci 2009;259:120–129.CrossRefGoogle Scholar
Roesler, M., Retz, W., Fischer, R., Ose, C., Alm, B., Deckert, J.et al.Twenty-four-week treatment with extended release methylphenidate improves emotional symptoms in adult ADHD. World J Biol Psychiatry 2010;11(5):709–718.CrossRefGoogle Scholar
Sabate, E.Adherence to long-term therapies: evidence for action. Geneva: World Health Organisation; 2003. Available from URL: http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf.Google Scholar
Safren, S.A., Duran, P., Yovel, I., Perlman, C.A., Sprich, S.Medication adherence in psychopharmacologically treated adults with ADHD. J Atten Dis 2007;10:257–260.CrossRefGoogle ScholarPubMed
Simon, V., Czobor, P., Balint, S.et al.Prevalence and correlates of adult attention deficit hyperactivity disorder: meta-analysis. Br J Psychiatry 2009;194:204–211.CrossRefGoogle ScholarPubMed
Sobanski, E., Brüggemann, D., Alm, B., Kern, S., Deschner, M., Schubert, T.et al.Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder. Eur Arch Psychiatry Clin Neurosci 2007;257:371–377.CrossRefGoogle Scholar
Sobanski, E., Sabljic, D., Alm, B., Dittmann, R.W., Wehmeier, P.M., Skopp, G.et al.Driving performance in adults with ADHD: results from a randomized, waiting-list controlled trial with atomoxetine. Eur Psychiatry 2013;28:379–385.CrossRefGoogle ScholarPubMed
Thompson, C.et al.Compliance with antidepressant medication in the treatment of major depressive disorder in primary care: a randomized comparison of fluoxetine and a tricyclic antidepressant. Am J Psychiatry 2000;157:338–343.CrossRefGoogle Scholar
Wittchen, H.-U., Zaudig, M., Fydrich, T.SKID-I und SKID-II Strukturiertes Klinisches Interview für DSM-IV. Goettingen: Hogrefe; 1997.Google Scholar
Wong, I.C.K., Asherson, P., Bilbow, A., Clifford, S., Coghill, D., DeSosy, R.et al.Cessation of attention deficit hyperactivity disorder drugs in the young (CADDY)–a pharmacoepidemiological and qualitative study. Health Technol Assess 13iii–iv, ix–xi2009 1–120.Google Scholar
World Health Organisation, ICD-10 classifications of mental and behavioural disorder: clinical descriptions and diagnostic guidelines. Geneva: World Health Organisation; 1992.Google Scholar
Submit a response

Comments

No Comments have been published for this article.