Divergence by ADHD subtype in smoking cessation response to OROS-methylphenidate
Lirio S Covey1, Mei-Chen Hu, Judith Weissman
1New York State Psychiatric Institute, Columbia University Medical Center, Psychiatry, Clinical Therapeutics, New York, NY, USA. lsc3@columbia.edu
Summary
Attention deficit hyperactivity disorder (ADHD) subtypes show different smoking cessation responses to methylphenidate. Nicotine dependence levels impact treatment effectiveness, suggesting personalized ADHD treatments for smokers.
Area of Science:
- Neuroscience
- Psychiatry
- Pharmacology
Background:
- Attention deficit hyperactivity disorder (ADHD) is classified into subtypes: inattentive (ADHD-IN), hyperactive/impulsive (ADHD-H), and combined (ADHD-C).
- The distinctness of these ADHD subtypes is debated, with treatment response variability potentially indicating heterogeneity.
- This study investigates smoking cessation outcomes based on ADHD subtype using a specific medication.
Purpose of the Study:
- To examine the efficacy of osmotic-release oral system methylphenidate (OROS-MPH) in aiding smoking cessation among different ADHD subtypes.
- To determine if ADHD subtypes respond differently to OROS-MPH augmentation therapy for smoking cessation.
- To explore the moderating role of nicotine dependence level on smoking cessation treatment response in ADHD subtypes.
Main Methods:
- Adult smokers with ADHD-C (n=167) and ADHD-IN (n=87) were enrolled in a randomized trial.
- Participants received either OROS-MPH or placebo as an adjunct to nicotine patch and counseling.
- Logistic regression analysis was used to assess the effect of OROS-MPH versus placebo on smoking abstinence, stratified by ADHD subtype and nicotine dependence level.
Main Results:
- ADHD subtypes did not differ in baseline characteristics but showed differential smoking cessation responses.
- A significant three-way interaction revealed that highly nicotine-dependent smokers with ADHD-C had higher abstinence rates with OROS-MPH (60%) versus placebo (31.3%).
- Conversely, highly nicotine-dependent smokers with ADHD-IN showed higher abstinence with placebo (60%) versus OROS-MPH (11.8%), while less dependent smokers showed no significant differences.
Conclusions:
- Differential treatment responses and the influence of nicotine dependence support ADHD subtypes as distinct clinical entities.
- Findings suggest that personalized treatment strategies are necessary for smokers with ADHD.
- Tailoring ADHD treatments based on subtype and nicotine dependence may improve smoking cessation outcomes.
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