title: Medication adherence and symptom reduction in adults treated with mixed amphetamine salts in a randomized crossover study.
abstract: OBJECTIVE
  The study objectives were to 1) evaluate medication adherence for adults with attention-deficit/hyperactivity disorder (ADHD) treated with 3 times daily (TID) mixed amphetamine salts immediate release (MAS IR) versus once-daily (qAM) MAS extended release (MAS XR) in a randomized, crossover study; and 2) to examine the associations between adherence and efficacy for MAS IR and MAS XR.
  
  
  METHODS
  Sixty-two adults with ADHD were enrolled and 49 completed the study. The treatment condition order (TID-qAM or qAM-TID) was counterbalanced across participants, with an intervening washout period of ≥ 7 days. Adherence was assessed via 3 measures: 1) self-report, 2) pill count, and 3) the Medication Event Monitoring System (MEMS(®)). The primary efficacy measure was the ADHD Rating Scale (ADHD-RS); secondary measures included the Time-Sensitive ADHD Symptom Scale (TASS) and Clinical Global Impressions-Severity of Illness (CGI-S) scale.
  
  
  RESULTS
  Adherence to treatment as measured by self-report and pill count was not significantly different between MAS XR and MAS IR. Adherence was significantly better for MAS XR than MAS IR for all of the MEMS(®) measures. The mean change in ADHD-RS, TASS, and CGI-S scores at endpoint was significantly improved for both MAS IR and MAS XR and did not differ significantly between groups. There was not a significant adherence by efficacy interaction.
  
  
  CONCLUSIONS
  Adults with ADHD adhered equally well with MAS IR as with MAS XR when assessed by pill count and self-report, but not by the MEMS(®) measures. Both treatments significantly reduced ADHD symptoms, and efficacy was not significantly different between groups. Adherence was not associated with treatment outcome.
authors: Department of Psychiatry, NYU School of Medicine, New York, NY 10016, USA. lenard.adler@nyumc.org
authors: Lenard A
authors: LA
authors: Adler
authors: Lauren R
authors: LR
authors: Lynch
authors: David M
authors: DM
authors: Shaw
authors: Samantha P
authors: SP
authors: Wallace
authors: Michael A
authors: MA
authors: Ciranni
authors: Alexis M
authors: AM
authors: Briggie
authors: Agatha
authors: A
authors: Kulaga
authors: Katherine E
authors: KE
authors: O'Donnell
authors: Stephen V
authors: SV
authors: Faraone
mesh_terms: D000293:Adolescent; D000328:Adult; D000661:Amphetamine / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000523:psychology; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants; D000661:Amphetamine