title: Patterns of long-term and short-term responses in adult patients with attention-deficit/hyperactivity disorder in a completer cohort of 12 weeks or more with atomoxetine.
abstract: BACKGROUND
  Atomoxetine is a well-established pharmacotherapy for adult ADHD. Long-term studies show incremental reductions in symptoms over time. However, clinical experience suggests that patients differ in their response patterns.
  
  
  METHODS
  From 13 Eli Lilly-sponsored studies, we pooled and analyzed data for adults with ADHD who completed atomoxetine treatment at long-term (24 weeks; n=1443) and/or short-term (12 weeks; n=2830) time-points, and had CAARS-Inv:SV total and CGI-S data up to or after these time-points and at Week 0 (i.e. at baseline, when patients first received atomoxetine). The goal was to identify and describe distinct trajectories of response to atomoxetine using hierarchical clustering methods and linear mixed modelling.
  
  
  RESULTS
  Based on the homogeneity of changes in CAARS-Inv:SV total scores, 5 response clusters were identified for patients who completed long-term (24 weeks) treatment with atomoxetine, and 4 clusters were identified for patients who completed short-term (12 weeks) treatment. Four of the 5 long-term clusters (comprising 95% of completer patients) showed positive trajectories: 2 faster responding clusters (L1 and L2), and 2 more gradually responding clusters (L3 and L4). Responses (i.e.≥30% reduction in CAARS-Inv:SV total score, and CGI-S score≤3) were observed at 8 and 24 weeks in 80% and 95% of completers in Cluster L1, versus 5% and 48% in Cluster L4.
  
  
  CONCLUSIONS
  While many adults with ADHD responded relatively rapidly to atomoxetine, others responded more gradually without a clear plateau at 24 weeks. Longer-term treatment may be associated with greater numbers of responders.
authors.affiliation: Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, University of Heidelberg, J5, 68159 Mannheim, Germany. Electronic address: Esther.Sobanski@zi-mannheim.de.
authors.forename: E
authors.initials: E
authors.lastname: Sobanski
authors.affiliation: Finnish Institute of Occupational Health, PL40, FIN-00250 Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, PL590, FIN-00250 HUS, Helsinki, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Leppämäki
authors.affiliation: Medical Department, Eli Lilly & Co. Ltd, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey, GU20 6PH, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Bushe
authors.affiliation: Global Statistical Sciences, Lilly Deutschland GmbH, Werner Reimers Str. 2-4, 61350 Bad Homburg, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Berggren
authors.affiliation: Medical Department, Lilly S.A., Avenida de la Industria, 30, 28108 Alcobendas, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Casillas
authors.affiliation: Medical Department, S.A Eli Lilly Benelux N.V., Markiesstraat 1/4B, B - 1000 Brussel, Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Deberdt
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use; D000328:Adult; D000069445:Atomoxetine Hydrochloride / Q000627:therapeutic use*; D001288:Attention / Q000187:drug effects*; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013995:Time; D016896:Treatment Outcome
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000069445:Atomoxetine Hydrochloride
keywords: ADHD; Atomoxetine; Clusters; Long-term; Patterns; Response