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OROS Methylphenidate (Concerta) in the Treatment of Adult ADHD

Primary Purpose

Attention Deficit Hyperactivity Disorder

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
OROS methylphenidate
Placebo
Sponsored by
University of Utah
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Attention Deficit Hyperactivity Disorder focused on measuring ADHD, adult, WRAADDS, OROS MPH, emotional dysregulation

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Adults meeting DSM-IV-Text Revision criteria for ADHD, the Utah Criteria for ADHD, and experiencing at least moderate impairment (a score of 4 or greater on the CGI-Severity Scale for ADHD at both Screening and Baseline visits) will be enrolled. Other criteria include:

  1. Subjects ages 18 to 65, inclusive;
  2. Female subjects are eligible to enter and participate in this study only if:

    • She is of non-childbearing potential; has a male sexual partner who is surgically sterilized; is on implant of levonorgestrel, injectable progesterone, or an oral contraceptive; has an intrauterine device (IUD); or is sexually inactive with a male partner.
    • Or agrees to use a double barrier method of contraception (any combination of physical and chemical methods) and has a negative urine pregnancy test at screening interview.
  3. Subject must be in general good health as determined by medical history, ECG, and other analysis that, in the judgment of the study physician, would confirm the patient's good health.
  4. Subjects must read and write at a level sufficient to provide written informed consent and complete study-related materials.

Exclusion Criteria:

  1. Subjects with other current DSM-IV Axis I Disorders including Current or lifetime history of psychosis, current bipolar disorder type I, current Major Depressive Disorder, and Current Anxiety Disorder (unless in the opinion of clinic physician ADHD is the primary disorder and causes the disability seen in the patient);
  2. Subjects with any other DSM-IV Axis II diagnosis so severe that it would suggest non-responsiveness to pharmacotherapy for ADHD or noncompliance with the protocol;
  3. Subjects at risk for suicide or a risk to harm others;
  4. History of Substance Dependence according to DSM-IV criteria within 3 months of screening;
  5. Subjects currently abusing illegal drugs or alcohol are excluded from the study;
  6. Positive urine screen for drugs of abuse at screening for patients who have a significant history of substance use but still meet criteria 4 and 5. Patients not at risk for substance abuse will not be given a urine drug screen;
  7. Subjects in whom stimulants would represent a risk such as those with a history of stimulant abuse,
  8. History of uncontrolled hypertension or significant cardiovascular disease;
  9. Any known or suspected significant medical or psychiatric illnesses (e.g., hepatic or renal insufficiency, pulmonary (asthma, chronic obstructive pulmonary disease, etc), gastrointestinal, endocrine, neurological or metabolic disturbances that, in the judgment of the investigator, may impair interpretation of study results or constitute a significant safety concern in the context of the clinical trial;
  10. Medications, including health food supplements judged by the investigator to be likely to have central nervous system activity (for example, St John's Wort, gingko leaf, and melatonin), are not permitted during the study. If the subject is taking the medication prior to study entry, there must be a 7 day washout period prior to Visit 2. We will ask for an honest report of all medications consumed between visits. In the event a medication with psychoactive properties is consumed, the patient will be counseled regarding the use of prohibited medications;
  11. Use of any medication not considered acceptable by the clinical investigator or the medical monitor during the 7-day period before the start of the study (Day 1);

Sites / Locations

  • Mood Disorders Clinic

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

OROS methylphenidate

placebo

Arm Description

This was a 4-week double-blind arm. Medication was initiated at 18 mg/day and increased every 2 or 3 days by 9 mg based on treatment response and side effects. Maximum dose - 90 mg/day. Patients were seen weekly. Generally a stable dose was seen in 2 weeks and maintained the last 2 weeks of the arm. Side effects were assessed at each visit.

This arm was identical to the active medication arm except that placebo replaced the active medication.

Outcomes

Primary Outcome Measures

Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS)
This is an investigator rated scale which assessed the 7 domains of the Utah Criteria of Adult ADHD

Secondary Outcome Measures

Clinical Global Impressions-Improvement (CGI-I)
This is a global measure in improvement in symptoms that is a Likert type scale
Clinical Global Impression - Severity (CGI-S)
This is a general measure of symptom severity assessed using a Likert type scale.
ADHD rating scale (ADHD-RS)
This is an investigator rated scale which assesses the DSM-IV symptoms.
Self Report Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS)
This is a patient rated scale that assesses the 7 domains of the Utah Criteria for adult ADHD as well as ODD, Social functioning and Learning difficulties.
Wisconsin Personality Inventory - IV (WISPI-IV)
This is a computerized personality inventory completed by the patients. It consists of 214 items which address the 10 DSM-IV personality disorders plus passive aggressive personality disorder.

Full Information

First Posted
August 8, 2014
Last Updated
August 12, 2014
Sponsor
University of Utah
Collaborators
McNeil Consumer & Specialty Pharmaceuticals, a Division of McNeil-PPC, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02215538
Brief Title
OROS Methylphenidate (Concerta) in the Treatment of Adult ADHD
Official Title
Concerta in the Treatment of Adult ADHD and a Comparison of Four Adult ADHD Scales and Effects on Personality
Study Type
Interventional

2. Study Status

Record Verification Date
August 2014
Overall Recruitment Status
Completed
Study Start Date
November 2004 (undefined)
Primary Completion Date
February 2006 (Actual)
Study Completion Date
June 2006 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Utah
Collaborators
McNeil Consumer & Specialty Pharmaceuticals, a Division of McNeil-PPC, Inc.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will look at the effectiveness of osmotic release oral system (OROS) methylphenidate (Concerta) in treating attention deficit hyperactvity disorder (ADHD) in adults. Concerta has received FDA approval for childhood ADHD and there is documentation that it is effective in adult ADHD. However this trial will explore its effectiveness in treating symptoms not a part of the Diagnostic and Statistical Manual-III (DSM-III) criteria. Subjects will experience one screening visit and one baseline visit. Those who meet admission criteria will enter the double-blind phase. This will involve two 4-week treatment periods one of which will involve the use of Concerta and the other a placebo pill. Subjects who complete the double-blind phase will be allowed to enter a 180-day, open-label Concerta phase designed to assess long-term effects.
Detailed Description
ADHD affects from 3 to 5% of children, persists into adolescence 40 to 70% of these children and continues into adulthood in at least 50% of affected adolescents. Pharmacotherapy for ADHD in adults has paralleled that used for children, with generally positive results (Spencer, 1998). Never-the-less, it is not clear that the dimensions of medication response in adults are the same as in children. The extent to which the symptoms change with age remains open to question. This trial is created to include a variety of outcome measures which will enhance the number of symptoms assessed. Methylphenidate was the first medication shown to be effective in treatment for adults with ADHD and continues to be widely used. Several studies have demonstrated the usefulness of methylphenidate in adult ADHD (Wender et al, 1985, Spencer et al, 1995). These studies have not shown any unexpected drawbacks to treatment with methylphenidate. The extended release formulations represent an improvement over the immediate release versions for many patients. This is a double-blind, placebo-controlled, randomized, crossover trial comparing OROS methylphenidate with placebo. The double-blind trial will be preceded by an enrollment period consisting of a screening visit followed by a baseline visit. Patients who continue to meet admission criteria at baseline will be randomized into the first of two 4-week treatment periods. We will attempt to reach the highest tolerated dose size within 2 weeks and then observe the response over the last two weeks of each crossover phase. The double-blind period will be followed by a 180 day open-treatment, flexible-dose phase designed to assess long-term effects.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Attention Deficit Hyperactivity Disorder
Keywords
ADHD, adult, WRAADDS, OROS MPH, emotional dysregulation

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Crossover Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
47 (Actual)

8. Arms, Groups, and Interventions

Arm Title
OROS methylphenidate
Arm Type
Experimental
Arm Description
This was a 4-week double-blind arm. Medication was initiated at 18 mg/day and increased every 2 or 3 days by 9 mg based on treatment response and side effects. Maximum dose - 90 mg/day. Patients were seen weekly. Generally a stable dose was seen in 2 weeks and maintained the last 2 weeks of the arm. Side effects were assessed at each visit.
Arm Title
placebo
Arm Type
Placebo Comparator
Arm Description
This arm was identical to the active medication arm except that placebo replaced the active medication.
Intervention Type
Drug
Intervention Name(s)
OROS methylphenidate
Other Intervention Name(s)
concerta
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo medication appears identical to the active medication OROS methylphenidate
Primary Outcome Measure Information:
Title
Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS)
Description
This is an investigator rated scale which assessed the 7 domains of the Utah Criteria of Adult ADHD
Time Frame
Baseline visit, Double-blind phase Week 4 each arm, Open-Label months 1-6
Secondary Outcome Measure Information:
Title
Clinical Global Impressions-Improvement (CGI-I)
Description
This is a global measure in improvement in symptoms that is a Likert type scale
Time Frame
Baseline; Double-blind phase Week 4 each arm: Open-Label months 1-6
Title
Clinical Global Impression - Severity (CGI-S)
Description
This is a general measure of symptom severity assessed using a Likert type scale.
Time Frame
Baseline visit; Double-blind phase Week 4 each arm: Open-Label months 1-6
Title
ADHD rating scale (ADHD-RS)
Description
This is an investigator rated scale which assesses the DSM-IV symptoms.
Time Frame
Baselinevisit; Double-blind phase Week 4 each arm: Open-Label final visit month 6
Title
Self Report Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS)
Description
This is a patient rated scale that assesses the 7 domains of the Utah Criteria for adult ADHD as well as ODD, Social functioning and Learning difficulties.
Time Frame
Baseline; Double-blind phases Week 4 each arm: Final visit of Open-Label period month 6
Title
Wisconsin Personality Inventory - IV (WISPI-IV)
Description
This is a computerized personality inventory completed by the patients. It consists of 214 items which address the 10 DSM-IV personality disorders plus passive aggressive personality disorder.
Time Frame
Baseline visit; Final Open-Label visit month 6

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adults meeting DSM-IV-Text Revision criteria for ADHD, the Utah Criteria for ADHD, and experiencing at least moderate impairment (a score of 4 or greater on the CGI-Severity Scale for ADHD at both Screening and Baseline visits) will be enrolled. Other criteria include: Subjects ages 18 to 65, inclusive; Female subjects are eligible to enter and participate in this study only if: She is of non-childbearing potential; has a male sexual partner who is surgically sterilized; is on implant of levonorgestrel, injectable progesterone, or an oral contraceptive; has an intrauterine device (IUD); or is sexually inactive with a male partner. Or agrees to use a double barrier method of contraception (any combination of physical and chemical methods) and has a negative urine pregnancy test at screening interview. Subject must be in general good health as determined by medical history, ECG, and other analysis that, in the judgment of the study physician, would confirm the patient's good health. Subjects must read and write at a level sufficient to provide written informed consent and complete study-related materials. Exclusion Criteria: Subjects with other current DSM-IV Axis I Disorders including Current or lifetime history of psychosis, current bipolar disorder type I, current Major Depressive Disorder, and Current Anxiety Disorder (unless in the opinion of clinic physician ADHD is the primary disorder and causes the disability seen in the patient); Subjects with any other DSM-IV Axis II diagnosis so severe that it would suggest non-responsiveness to pharmacotherapy for ADHD or noncompliance with the protocol; Subjects at risk for suicide or a risk to harm others; History of Substance Dependence according to DSM-IV criteria within 3 months of screening; Subjects currently abusing illegal drugs or alcohol are excluded from the study; Positive urine screen for drugs of abuse at screening for patients who have a significant history of substance use but still meet criteria 4 and 5. Patients not at risk for substance abuse will not be given a urine drug screen; Subjects in whom stimulants would represent a risk such as those with a history of stimulant abuse, History of uncontrolled hypertension or significant cardiovascular disease; Any known or suspected significant medical or psychiatric illnesses (e.g., hepatic or renal insufficiency, pulmonary (asthma, chronic obstructive pulmonary disease, etc), gastrointestinal, endocrine, neurological or metabolic disturbances that, in the judgment of the investigator, may impair interpretation of study results or constitute a significant safety concern in the context of the clinical trial; Medications, including health food supplements judged by the investigator to be likely to have central nervous system activity (for example, St John's Wort, gingko leaf, and melatonin), are not permitted during the study. If the subject is taking the medication prior to study entry, there must be a 7 day washout period prior to Visit 2. We will ask for an honest report of all medications consumed between visits. In the event a medication with psychoactive properties is consumed, the patient will be counseled regarding the use of prohibited medications; Use of any medication not considered acceptable by the clinical investigator or the medical monitor during the 7-day period before the start of the study (Day 1);
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Frederick W Reimherr, MD
Organizational Affiliation
Univeristy of Utah Dept of Psychiatry
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mood Disorders Clinic
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84105
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20680193
Citation
Marchant BK, Reimherr FW, Halls C, Williams ED, Strong RE. OROS methylphenidate in the treatment of adults with ADHD: a 6-month, open-label, follow-up study. Ann Clin Psychiatry. 2010 Aug;22(3):196-204.
Results Reference
result
PubMed Identifier
20445837
Citation
Reimherr FW, Marchant BK, Williams ED, Strong RE, Halls C, Soni P. Personality disorders in ADHD Part 3: Personality disorder, social adjustment, and their relation to dimensions of adult ADHD. Ann Clin Psychiatry. 2010 May;22(2):103-12.
Results Reference
result
PubMed Identifier
20445836
Citation
Robison RJ, Reimherr FW, Gale PD, Marchant BK, Williams ED, Soni P, Halls C, Strong RE. Personality disorders in ADHD Part 2: The effect of symptoms of personality disorder on response to treatment with OROS methylphenidate in adults with ADHD. Ann Clin Psychiatry. 2010 May;22(2):94-102.
Results Reference
result
PubMed Identifier
20445835
Citation
Williams ED, Reimherr FW, Marchant BK, Strong RE, Halls C, Soni P, Gale PD, Robison RJ. Personality disorder in ADHD Part 1: Assessment of personality disorder in adult ADHD using data from a clinical trial of OROS methylphenidate. Ann Clin Psychiatry. 2010 May;22(2):84-93.
Results Reference
result
PubMed Identifier
17284136
Citation
Reimherr FW, Williams ED, Strong RE, Mestas R, Soni P, Marchant BK. A double-blind, placebo-controlled, crossover study of osmotic release oral system methylphenidate in adults with ADHD with assessment of oppositional and emotional dimensions of the disorder. J Clin Psychiatry. 2007 Jan;68(1):93-101. doi: 10.4088/jcp.v68n0113.
Results Reference
result
PubMed Identifier
27082828
Citation
Gift TE, Reimherr FW, Marchant BK, Steans TA, Wender PH. Personality Disorder in Adult Attention-Deficit/Hyperactivity Disorder: Attrition and Change During Long-term Treatment. J Nerv Ment Dis. 2016 May;204(5):355-63. doi: 10.1097/NMD.0000000000000470.
Results Reference
derived

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OROS Methylphenidate (Concerta) in the Treatment of Adult ADHD

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