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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).
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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

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