Predictors of treatment outcome in adults with ADHD treated with OROS® methylphenidate

Prog Neuropsychopharmacol Biol Psychiatry. 2011 Mar 30;35(2):554-60. doi: 10.1016/j.pnpbp.2010.12.016. Epub 2010 Dec 23.

Abstract

Background: We conducted a post-hoc analysis of the Long-Acting MethylpheniDate in Adult attention-deficit hyperactivity disorder (LAMDA) study to investigate predictors of response in adults with ADHD randomly assigned to Osmotic Release Oral System (OROS)(®)-methylphenidate hydrochloride (MPH) 18, 36 or 72 mg or placebo.

Methods: LAMDA comprised a 5-week, double-blind (DB) period, followed by a 7-week, open-label (OL) period. A post-hoc analysis of covariance and a logistic regression analysis were undertaken to detect whether specific baseline parameters or overall treatment compliance during the double-blind phase contributed to response. The initial model included all covariates as independent variables; a backward stepwise selection method was used, with stay criteria of p<0.10. Six outcomes were considered: change from baseline CAARS:O-SV (physician-rated) and CAARS:S-S (self-report) scores at DB and OL end points, and response rate (≥30% decrease in CAARS:O-SV score from baseline) and normalization of CAARS:O-SV score at DB end point.

Results: Taking into account a significant effect of OROS(®)-MPH treatment versus placebo in the original analysis (p≤0.015), across the outcomes considered in this post-hoc analysis, higher baseline CAARS scores were most strongly predictive of superior outcomes. Male gender and lower academic achievement were also predictive for improved results with certain outcomes.

Conclusions: Several baseline factors may help to predict better treatment outcomes in adults receiving OROS(®)-MPH; however, further research is required to confirm these findings and examine their neurobiological underpinnings.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Attention Deficit Disorder with Hyperactivity / drug therapy*
  • Central Nervous System Stimulants / administration & dosage
  • Central Nervous System Stimulants / pharmacokinetics*
  • Central Nervous System Stimulants / therapeutic use*
  • Delayed-Action Preparations
  • Double-Blind Method
  • Educational Status
  • Female
  • Humans
  • Male
  • Methylphenidate / administration & dosage
  • Methylphenidate / pharmacokinetics*
  • Methylphenidate / therapeutic use*
  • Middle Aged
  • Osmosis
  • Placebos
  • Psychiatric Status Rating Scales
  • Sex Characteristics
  • Treatment Outcome

Substances

  • Central Nervous System Stimulants
  • Delayed-Action Preparations
  • Placebos
  • Methylphenidate