Lam, Alexandra P. and Matthies, Swantje and Graf, Erika and Colla, Michael and Jacob, Christian and Sobanski, Esther and Alm, Barbara and Roesler, Michael and Retz, Wolfgang and Retz-Junginger, Petra and Kis, Bernhard and Abdel-Hamid, Mona and Mueller, Helge H. O. and Luecke, Caroline and Huss, Michael and Jans, Thomas and Berger, Mathias and van Elst, Ludger Tebartz and Philipsen, Alexandra and Heuser, Isabella and Colla, Michael and Gentschow, Laura and Kunze, Paula and Langner, Daina and Lam, Alexandra and Wiltfang, Jens and Kis, Bernhard and Abdel-Hamid, Mona and Heinrich, Viola and Kraemer, Markus and Uekermann, Jennifer and Philipsen, Alexandra and Graf, Erika and Matthies, Swantje and Loewer, Marc and Borel, Patricia and Jansen, Imke and Bonfico, Steffi and Joossens, Manuel and Sadohara, Chiharu and Weber, Manfred and Kamp, Melanie and Dopatka, Tatja and Perlov, Evgeniy and Richter, Harald and Roesler, Michael and Retz, Wolfgang and Retz-Junginger, Petra and Roemer, Konstanze and Leipnitz, Birgit and Doyran, Sabine and Schulte-Altedorneburg, Monika and Carl, Christine and Keutler, Clemens and Huss, Michael and Kornmann, Catherine and Buerger, Arne and Chervenkova, Galina and Meinhardt, Patricia and Meyer-Lindenberg, Andreas and Sobanski, Esther and Alm, Barbara and Schumacher-Stien, Martina and Bukow, Simon and Argiriou-Martin, Sotiria and Deckert, Juergen and Warnke, Andreas and Jacob, Christian and Jans, Thomas and Gross-Lesch, Silke and Heine, Monika and Boreatti-Huemmer, Andrea and Heupel, Julia and Reichert, Susanne and Mueller, Sabine and Kreiker, Susanne and Gessner, Alexandra and Conzelmann, Annette and Baehne, Christina and Bredenkamp, Rainer and Ihorst, Gabriele and Graf, Erika and Remschmidt, Helmut and Wassmer, Gernot and Wodarz, Norbert and Frank, Ulrike and Mayer-Bruns, Friederike and Schehr, Kirsten and Schlander, Michael (2019) Long-term Effects of Multimodal Treatment on Adult Attention-Deficit/Hyperactivity Disorder Symptoms Follow-up Analysis of the COMPAS Trial. JAMA NETWORK OPEN, 2 (5): e194980. ISSN 2574-3805,
Full text not available from this repository. (Request a copy)Abstract
IMPORTANCE Knowledge about the long-term effects of multimodal treatment in adult attention-deficit/hyperactivity disorder (ADHD) is much needed. OBJECTIVE To evaluate the long-term efficacy of multimodal treatment for adult ADHD. DESIGN, SETTING, AND PARTICIPANTS This observer-masked, 1.5-year follow-up of the Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS), a prospective, multicenter randomized clinical trial, compared cognitive behavioral group psychotherapy (GPT) with individual clinical management (CM) and methylphenidate (MPH) with placebo (2 x 2 factorial design). Recruitment started January 2007 and ended August 2010, and treatments were finalized in August 2011 with follow-up through March 2013. Overall, 433 adults with ADHD participated in the trial, and 256 (59.1%) participated in the follow-up assessment. Analysis began in November 2013 and was completed in February 2018. INTERVENTIONS After 1-year treatment with GPT or CM and MPH or placebo, no further treatment restrictions were imposed. MAIN OUTCOMES AND MEASURES The primary outcome was change in the observer-masked ADHD Index of Conners Adult ADHD Rating Scale score from baseline to follow-up. Secondary outcomes included further ADHD rating scale scores, observer-masked ratings of the Clinical Global Impression scale, and self-ratings of depression on the Beck Depression Inventory. RESULTS At follow-up, 256 of 433 randomized patients (baseline measured in 419 individuals) participated. Of the 256 patients participating in follow-up, the observer-masked ADHD Index of Conners Adult ADHD Rating Scale score was assessed for 251; the mean (SD) baseline age was 36.3 (10.1) years; 125 patients (49.8%) were men; and the sample was well-balanced with respect to prior randomization (GPT and MPH: 64 of 107; GPT and placebo: 67 of 109; CM and MPH: 70 of 110; and CM and placebo: 55 of 107). At baseline, the all-group mean ADHD Index of Conners Adult ADHD Rating Scale score was 20.6, which improved to adjusted means of 14.2 for the GPT arm and 14.7 for the CM arm at follow-up with no significant difference between groups (difference, -0.5; 95% CI, -1.9 to 0.9; P=.48). The adjusted mean decreased to 13.8 for the MPH arm and 15.2 for the placebo arm (difference, -1.4; 95% CI, -2.8 to -0.1; P=.04). As in the core study, MPH was associated with a larger reduction in symptoms than placebo at follow-up. These results remained unchanged when accounting for MPH intake at follow-up. Compared with participants in the CM arm, patients who participated in group psychotherapy were associated with less severe symptoms as measured by the self-reported ADHD Symptoms Total Score according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) of Conners Adult ADHD Rating Scale (AMD, -2.1; 95% CI, -4.2 to -0.1; P=.04) and in the subscale of reducing pure hyperactive symptoms, measured via the Diagnostic Checklist for the diagnosis of ADHD in adults (AMD, -1.3; 95% CI, -2.8 to 0.1; P=.08). Regarding the Clinical Global Impression scale assessment of effectiveness, the difference between GPT and CM remained significant at follow-up (odds ratio, 1.63; 95% CI, 1.03-2.59; P=.04). No differences were found for any comparison concerning depression as measured with the Beck Depression Inventory. CONCLUSIONS AND RELEVANCE Results from COMPAS demonstrate a maintained improvement in ADHD symptoms for adults 1.5 years after the end of a 52-week controlled multimodal treatment period. The results indicate that MPH treatment combined with GPT or CM provides a benefit lasting 1.5 years. Confirming the results of the core study, GPT was not associated with better results regarding the primary outcome compared with CM. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN54096201
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | DEFICIT HYPERACTIVITY DISORDER; COGNITIVE-BEHAVIORAL THERAPY; MEDICATION-TREATED ADULTS; METHYLPHENIDATE TREATMENT; GERMAN VALIDATION; DOUBLE-BLIND; ADHD; DOPAMINE; CHILDREN; PLACEBO; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Psychiatrie und Psychotherapie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 08 Apr 2020 12:32 |
| Last Modified: | 08 Apr 2020 12:32 |
| URI: | https://pred.uni-regensburg.de/id/eprint/27039 |
Actions (login required)
 |
View Item |
