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Treating Nicotine Dependence by Targeting Attention Deficit/Hyperactivity Disorder (ADHD) with OROS Methylphenidate: The Role of Baseline ADHD Severity and Treatment Response.

Journal of Clinical Psychiatry 2013;74(10):983-990. [doi: 10.4088/JCP.12m08155]

Edward V. Nunes, MD (New York State Psychiatric Institute, GNY Node), Lirio S. Covey, PhD (Columbia University Medical Center, GNY Node), Gregory S. Brigham, PhD (Maryhaven Inc., OV Node), Mei-Chen Hu, PhD (Columbia University, GNY Node), Frances R. Levin, MD (New York State Psychiatric Institute, GNY Node), Eugene C. Somoza, MD, PhD (University of Cincinnati/CinARC, OV Node), Theresa M. Winhusen, PhD (University of Cincinnati/CinARC, OV Node).

This secondary analysis of data from National Drug Abuse Treatment Clinical Trials Network protocol CTN-0029 (NIDA-CTN-0029 A Pilot Study of Osmotic-Release Methylphenidate in Initiating and Maintaining Abstinence in Smokers with ADHD) aimed to determine whether treatment of attention deficit/hyperactivity disorder (ADHD) with osmotic-release oral system (OROS) methylphenidate promotes abstinence from smoking among smokers with ADHD who have greater severity of ADHD symptoms at baseline or greater improvement in ADHD during treatment. CTN-0029 was a randomized, double-blind, 11-week trial conducted between December 2005 and January 2008 at 6 clinical sites. Adult cigarette smokers (aged 18-55 years) who met DSM-IV criteria for ADHD were randomly assigned to OROS methylphenidate (72 mg/d) (n=127) or matching placebo (n=128). All participants received nicotine patches (21 mg/d) and weekly individual smoking cessation counseling. Logistic regression was used to model prolonged abstinence from smoking (ascertained by self-report and breath carbon monoxide testing) as a function of treatment, baseline ADHD Rating Scale-IV (ADHD-RS) score, change in ADHD-RS score during treatment, and their interactions.

Results found that treatment interacted with both ADHD-RS score at baseline and change in ADHD-RS score during treatment. Among patients with higher ADHD-RS scores (>36) at baseline and the most improvement in ADHD during treatment (change score > 24), 70% of those who took OROS methylphenidate achieved abstinence from smoking compared to 36.8% of those who took placebo. In contrast, among patients with the lowest ADHD-RS baseline scores (< 30), 30.3% of those who took OROS methylphenidate achieved abstinence from smoking compared to 60.7% of those who took placebo.

Conclusions: OROS methylphenidate, in combination with nicotine patch, may be an effective treatment for nicotine dependence among smokers with more severe ADHD and more robust response of ADHD symptoms to medication. OROS methylphenidate may be counterproductive among smokers with lower severity of ADHD. The identification and aggressive treatment of ADHD and other comorbidities hold out the promise of a treatment strategy complementary to existing medication and behavioral approaches. (Article (Peer-Reviewed), PDF, English, 2013)

Keywords: ADHD Rating Scale (ADHD-RS) | Attention Deficit Hyperactivity Disorder (ADHD) | CTN platform/ancillary study | Nicotine replacement therapy | Osmotic-Release Methylphenidate (OROS-MPH) | Pharmacological therapy | Smoking | Journal of Clinical Psychiatry (journal)

Document No: 954, PMID: 24229749, PMCID: PMC3946795.

Submitted by CTN Dissemination Librarians, 11/25/2013.


Brigham, Gregory S. mail
Covey, Lirio S. mail
Hu, Mei-Chen search
Levin, Frances R. search mail
Nunes, Edward V. mail
Somoza, Eugene C. mail
Winhusen, Theresa M. mail
CTN-0029 www
Ohio Valley Node (Lead) www
Greater New York www
New England Consortium www
Western States www

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