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OROS Methylphenidate (Concerta) in the Treatment of Adult ADHD

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02215538
Recruitment Status : Completed
First Posted : August 13, 2014
Last Update Posted : August 13, 2014
McNeil Consumer & Specialty Pharmaceuticals, a Division of McNeil-PPC, Inc.
Information provided by (Responsible Party):
frederick reimherr, University of Utah

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.

Condition or disease Intervention/treatment Phase
Attention Deficit Hyperactivity Disorder Drug: OROS methylphenidate Drug: Placebo Phase 2 Phase 3

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.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 47 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Concerta in the Treatment of Adult ADHD and a Comparison of Four Adult ADHD Scales and Effects on Personality
Study Start Date : November 2004
Actual Primary Completion Date : February 2006
Actual Study Completion Date : June 2006

Arm Intervention/treatment
Experimental: OROS methylphenidate
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.
Drug: OROS methylphenidate
Other Name: concerta

Placebo Comparator: placebo
This arm was identical to the active medication arm except that placebo replaced the active medication.
Drug: Placebo
Placebo medication appears identical to the active medication OROS methylphenidate

Primary Outcome Measures :
  1. Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) [ Time Frame: Baseline visit, Double-blind phase Week 4 each arm, Open-Label months 1-6 ]
    This is an investigator rated scale which assessed the 7 domains of the Utah Criteria of Adult ADHD

Secondary Outcome Measures :
  1. Clinical Global Impressions-Improvement (CGI-I) [ Time Frame: Baseline; Double-blind phase Week 4 each arm: Open-Label months 1-6 ]
    This is a global measure in improvement in symptoms that is a Likert type scale

  2. Clinical Global Impression - Severity (CGI-S) [ Time Frame: Baseline visit; Double-blind phase Week 4 each arm: Open-Label months 1-6 ]
    This is a general measure of symptom severity assessed using a Likert type scale.

  3. ADHD rating scale (ADHD-RS) [ Time Frame: Baselinevisit; Double-blind phase Week 4 each arm: Open-Label final visit month 6 ]
    This is an investigator rated scale which assesses the DSM-IV symptoms.

  4. Self Report Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS) [ Time Frame: Baseline; Double-blind phases Week 4 each arm: Final visit of Open-Label period month 6 ]
    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.

  5. Wisconsin Personality Inventory - IV (WISPI-IV) [ Time Frame: Baseline visit; Final Open-Label visit month 6 ]
    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.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

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);

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02215538

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United States, Utah
Mood Disorders Clinic
Salt Lake City, Utah, United States, 84105
Sponsors and Collaborators
University of Utah
McNeil Consumer & Specialty Pharmaceuticals, a Division of McNeil-PPC, Inc.
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Principal Investigator: Frederick W Reimherr, MD Univeristy of Utah Dept of Psychiatry
Publications of Results:
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: frederick reimherr, Director, Mood Disorders Clinic, University of Utah Identifier: NCT02215538    
Other Study ID Numbers: 00012246
First Posted: August 13, 2014    Key Record Dates
Last Update Posted: August 13, 2014
Last Verified: August 2014
Keywords provided by frederick reimherr, University of Utah:
emotional dysregulation
Additional relevant MeSH terms:
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Attention Deficit Disorder with Hyperactivity
Attention Deficit and Disruptive Behavior Disorders
Neurodevelopmental Disorders
Mental Disorders
Central Nervous System Stimulants
Physiological Effects of Drugs
Dopamine Uptake Inhibitors
Neurotransmitter Uptake Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Dopamine Agents
Neurotransmitter Agents