Divergence by ADHD subtype in smoking cessation response to OROS-methylphenidate

Lirio S. Covey, Mei Chen Hu, Judith Weissman, Ivana T Croghan, Lenard Adler, Theresa Winhusen

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Introduction: Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric condition subclassified in DSM-IV according to its core symptoms domains as (a) predominantly inattentive (ADHD-IN), (b) predominantly hyperactive/impulsive (ADHD-H), and (c) combined inattentive and hyperactive/impulsive (ADHD-C). Whether these subtypes represent distinct clinical entities or points on a severity continuum is controversial. Divergence in treatment response is a potential indicator of qualitative heterogeneity. This study examined smoking cessation response by ADHD subtype to osmotic-release oral system methylphenidate (OROS-MPH). Methods: Male and female adult smokers (ADHD-C = 167 and ADHD-IN = 87) were randomized to receive OROS-MPH or placebo as augmentation treatment to nicotine patch and counseling. Logistic regression was conducted to test the effect of OROS-MPH versus placebo on prolonged smoking abstinence by ADHD subtype. Results: The subtypes were similar in baseline demographic, smoking, and psychiatric history but differed in smoking cessation response to OROS-MPH or placebo as a function of nicotine dependence level. The 3-way interaction was significant; x 2(1) = 8.22, p < .01. Among highly dependent smokers, the prolonged abstinence rates were greater with OROS-MPH than with placebo in the ADHD-C group (60% vs. 31.3%, respectively, p < .05) but higher with placebo than with OROS-MPH in the ADHD-IN group (60% vs. 11.8%, respectively, p < .01). Abstinence rates did not differ by subtype or treatment among smokers who were less nicotine dependent. Conclusion: Contrasting treatment response and divergence in the impact of nicotine dependence level support the hypothesis comof ADHD subtypes as distinct clinical entities and may indicate the need and directions for personalized targeted treatments of smokers with ADHD.

Original languageEnglish (US)
Pages (from-to)1003-1008
Number of pages6
JournalNicotine and Tobacco Research
Volume13
Issue number10
DOIs
StatePublished - Oct 2011

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Methylphenidate
Smoking Cessation
Attention Deficit Disorder with Hyperactivity
Placebos
Tobacco Use Disorder
Smoking
Tobacco Use Cessation Products
Therapeutics
Nicotine
Diagnostic and Statistical Manual of Mental Disorders
Psychiatry
Counseling
Logistic Models
Demography

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Divergence by ADHD subtype in smoking cessation response to OROS-methylphenidate. / Covey, Lirio S.; Hu, Mei Chen; Weissman, Judith; Croghan, Ivana T; Adler, Lenard; Winhusen, Theresa.

In: Nicotine and Tobacco Research, Vol. 13, No. 10, 10.2011, p. 1003-1008.

Research output: Contribution to journalArticle

Covey, Lirio S. ; Hu, Mei Chen ; Weissman, Judith ; Croghan, Ivana T ; Adler, Lenard ; Winhusen, Theresa. / Divergence by ADHD subtype in smoking cessation response to OROS-methylphenidate. In: Nicotine and Tobacco Research. 2011 ; Vol. 13, No. 10. pp. 1003-1008.
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abstract = "Introduction: Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric condition subclassified in DSM-IV according to its core symptoms domains as (a) predominantly inattentive (ADHD-IN), (b) predominantly hyperactive/impulsive (ADHD-H), and (c) combined inattentive and hyperactive/impulsive (ADHD-C). Whether these subtypes represent distinct clinical entities or points on a severity continuum is controversial. Divergence in treatment response is a potential indicator of qualitative heterogeneity. This study examined smoking cessation response by ADHD subtype to osmotic-release oral system methylphenidate (OROS-MPH). Methods: Male and female adult smokers (ADHD-C = 167 and ADHD-IN = 87) were randomized to receive OROS-MPH or placebo as augmentation treatment to nicotine patch and counseling. Logistic regression was conducted to test the effect of OROS-MPH versus placebo on prolonged smoking abstinence by ADHD subtype. Results: The subtypes were similar in baseline demographic, smoking, and psychiatric history but differed in smoking cessation response to OROS-MPH or placebo as a function of nicotine dependence level. The 3-way interaction was significant; x 2(1) = 8.22, p < .01. Among highly dependent smokers, the prolonged abstinence rates were greater with OROS-MPH than with placebo in the ADHD-C group (60{\%} vs. 31.3{\%}, respectively, p < .05) but higher with placebo than with OROS-MPH in the ADHD-IN group (60{\%} vs. 11.8{\%}, respectively, p < .01). Abstinence rates did not differ by subtype or treatment among smokers who were less nicotine dependent. Conclusion: Contrasting treatment response and divergence in the impact of nicotine dependence level support the hypothesis comof ADHD subtypes as distinct clinical entities and may indicate the need and directions for personalized targeted treatments of smokers with ADHD.",
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AB - Introduction: Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric condition subclassified in DSM-IV according to its core symptoms domains as (a) predominantly inattentive (ADHD-IN), (b) predominantly hyperactive/impulsive (ADHD-H), and (c) combined inattentive and hyperactive/impulsive (ADHD-C). Whether these subtypes represent distinct clinical entities or points on a severity continuum is controversial. Divergence in treatment response is a potential indicator of qualitative heterogeneity. This study examined smoking cessation response by ADHD subtype to osmotic-release oral system methylphenidate (OROS-MPH). Methods: Male and female adult smokers (ADHD-C = 167 and ADHD-IN = 87) were randomized to receive OROS-MPH or placebo as augmentation treatment to nicotine patch and counseling. Logistic regression was conducted to test the effect of OROS-MPH versus placebo on prolonged smoking abstinence by ADHD subtype. Results: The subtypes were similar in baseline demographic, smoking, and psychiatric history but differed in smoking cessation response to OROS-MPH or placebo as a function of nicotine dependence level. The 3-way interaction was significant; x 2(1) = 8.22, p < .01. Among highly dependent smokers, the prolonged abstinence rates were greater with OROS-MPH than with placebo in the ADHD-C group (60% vs. 31.3%, respectively, p < .05) but higher with placebo than with OROS-MPH in the ADHD-IN group (60% vs. 11.8%, respectively, p < .01). Abstinence rates did not differ by subtype or treatment among smokers who were less nicotine dependent. Conclusion: Contrasting treatment response and divergence in the impact of nicotine dependence level support the hypothesis comof ADHD subtypes as distinct clinical entities and may indicate the need and directions for personalized targeted treatments of smokers with ADHD.

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