title: Treatment adherence and persistence in adult ADHD: results from a twenty-four week controlled clinical trial with extended release methylphenidate.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, University of Heidelberg, J 5, 68159 Mannheim, Germany. Electronic address: esther.sobanski@zi-mannheim.de.
authors.forename: E
authors.initials: E
authors.lastname: Sobanski
authors.affiliation: Neurocentre, University Hospital of the Saarland, 66421 Homburg/Saar, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Retz
authors.affiliation: Medice Arzneimittel Pütter GmbH & Co KG, Kuhloweg 37, 58638 Iserlohn, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Fischer
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine of University Hospital, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Ose
authors.affiliation: Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, University of Heidelberg, J 5, 68159 Mannheim, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Alm
authors.affiliation: Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, University of Heidelberg, J 5, 68159 Mannheim, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Hennig
authors.affiliation: Neurocentre, University Hospital of the Saarland, 66421 Homburg/Saar, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Rösler
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000627:therapeutic use*; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008774:Methylphenidate / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants; D003692:Delayed-Action Preparations; D008774:Methylphenidate
keywords: ADHD; Adherence; Adults; Methylphenidate; Persistence