Trial Outcomes & Findings for Smoking Cessation for Adults With Attention Deficit Hyperactivity Disorder (ADHD) (NCT NCT00253747)

NCT ID: NCT00253747

Last Updated: 2012-09-17

Results Overview

The smoking quit date was considered the first day of the O-MPH/P-Stnd Smoking Tx phase, which lasted for 6 weeks or more precisely 42 days (i.e., approximately weeks 5-10). The grace period was the first two weeks (i.e., days 1-14) with the remaining four weeks (days 15-42) comprising the period in which the participant must not meet criteria for treatment failure in order to be scored as obtaining prolonged abstinence. Self-report of cigarette use was assessed using a time-line follow-back (TLFB) assessment using carbon monoxide (CO)levels to correct self-reported smoking days. "Smoking days" were determined by starting with self-reported smoking and non-smoking days and using CO levels measured at weekly visits to modify the self-reports.

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

255 participants

Primary outcome timeframe

Weeks 7-10

Results posted on

2012-09-17

Participant Flow

This trial was conducted by the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) between December 2005 and January 2008. Six study sites recruited participants: 2 substance abuse community treatment programs, 2 Attention Deficit Hyperactivity Disorder (ADHD) clinics and 2 smoking cessation clinics.

Participant milestones

Participant milestones
Measure
Osmotic-Release Methylphenidate (OROS-MPH)
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Overall Study
STARTED
127
128
Overall Study
COMPLETED
103
101
Overall Study
NOT COMPLETED
24
27

Reasons for withdrawal

Reasons for withdrawal
Measure
Osmotic-Release Methylphenidate (OROS-MPH)
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Overall Study
Lost to Follow-up
13
14
Overall Study
Withdrawal by Subject
10
11
Overall Study
Administrative Discharge (1), Other (2)
1
2

Baseline Characteristics

Smoking Cessation for Adults With Attention Deficit Hyperactivity Disorder (ADHD)

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Osmotic-Release Methylphenidate (OROS-MPH)
n=127 Participants
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo
n=128 Participants
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Total
n=255 Participants
Total of all reporting groups
Age, Categorical
<=18 years
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Age, Categorical
Between 18 and 65 years
127 Participants
n=5 Participants
128 Participants
n=7 Participants
255 Participants
n=5 Participants
Age, Categorical
>=65 years
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Age Continuous
38.1 years
STANDARD_DEVIATION 10.4 • n=5 Participants
37.5 years
STANDARD_DEVIATION 9.6 • n=7 Participants
37.8 years
STANDARD_DEVIATION 10.0 • n=5 Participants
Sex: Female, Male
Female
50 Participants
n=5 Participants
61 Participants
n=7 Participants
111 Participants
n=5 Participants
Sex: Female, Male
Male
77 Participants
n=5 Participants
67 Participants
n=7 Participants
144 Participants
n=5 Participants
Region of Enrollment
United States
127 participants
n=5 Participants
128 participants
n=7 Participants
255 participants
n=5 Participants

PRIMARY outcome

Timeframe: Weeks 7-10

Population: Randomized participants who complete at least two visits during the first four weeks following randomization, who reach the full dose of OROS-MPH /Placebo, who have a OROS-MPH /placebo medication compliance rate of at least 75% each week for study weeks 4 through 10, and who attend at least one meeting after initiating the nicotine patch.

The smoking quit date was considered the first day of the O-MPH/P-Stnd Smoking Tx phase, which lasted for 6 weeks or more precisely 42 days (i.e., approximately weeks 5-10). The grace period was the first two weeks (i.e., days 1-14) with the remaining four weeks (days 15-42) comprising the period in which the participant must not meet criteria for treatment failure in order to be scored as obtaining prolonged abstinence. Self-report of cigarette use was assessed using a time-line follow-back (TLFB) assessment using carbon monoxide (CO)levels to correct self-reported smoking days. "Smoking days" were determined by starting with self-reported smoking and non-smoking days and using CO levels measured at weekly visits to modify the self-reports.

Outcome measures

Outcome measures
Measure
Osmotic-Release Methylphenidate (OROS-MPH)
n=38 Participants
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo
n=42 Participants
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH)-Week 11
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo-Week 11
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Release Methylphenidate (OROS-MPH)-Week 4
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo-Week 4
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Release Methylphenidate (OROS-MPH)-Week 7
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo-Week 7
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Release Methylphenidate (OROS-MPH)-Week 9
OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Methylphenidate (OROS-MPH) - Placebo-Week 9
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Prolonged Abstinence
25 participants
28 participants

SECONDARY outcome

Timeframe: Baseline and Study weeks 1,4,7,9,11

Population: Evaluable participants determined using criteria for same in the primary outcome.

A Generalized Estimating Equations(GEE)model which included treatment group, week, site, and treatment by week and site by week interaction effects was used to compare the groups on the DSM-IV ADHD total severity score (18 domains score at severity levels of 0\[none\]-3\[severe\]; maximum score 54) as measured at screening/baseline and study weeks 1-4 using the the interviewer-administered DSM-IV checklist and by the severity portion of the National Institute of Mental Health Clinical Global Impression (CGI) scale to rate the severity of the participant's ADHD symptoms. A single severity score ranging from 1 to 7 is yielded by the CGI severity scale.

Outcome measures

Outcome measures
Measure
Osmotic-Release Methylphenidate (OROS-MPH)
n=38 Participants
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo
n=42 Participants
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH)-Week 11
n=38 Participants
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo-Week 11
n=42 Participants
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Release Methylphenidate (OROS-MPH)-Week 4
n=37 Participants
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo-Week 4
n=42 Participants
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Release Methylphenidate (OROS-MPH)-Week 7
n=35 Participants
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo-Week 7
n=42 Participants
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Release Methylphenidate (OROS-MPH)-Week 9
n=36 Participants
OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Methylphenidate (OROS-MPH) - Placebo-Week 9
n=40 Participants
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Diagnostic and Statistical Manual-IV(DSM-IV) ADHD Rating Scale
38.4 DSM IV ADHD Score
Standard Deviation 7.6
36.6 DSM IV ADHD Score
Standard Deviation 7.7
16.4 DSM IV ADHD Score
Standard Deviation 12.2
24.2 DSM IV ADHD Score
Standard Deviation 23.0
20.4 DSM IV ADHD Score
Standard Deviation 12.6
27.2 DSM IV ADHD Score
Standard Deviation 12.0
20 DSM IV ADHD Score
Standard Deviation 12.6
24 DSM IV ADHD Score
Standard Deviation 13.3
17.3 DSM IV ADHD Score
Standard Deviation 12.6
23.9 DSM IV ADHD Score
Standard Deviation 13.6

SECONDARY outcome

Timeframe: Week 11

Population: Evaluable population determined as for primary outcome.

A logistic regression including site and treatment group will be used to model rates of achieving point prevalence abstinence as assessed at the final visit of the O-MPH/P-Stnd Smoking Tx phase. Point prevalence abstinence was defined as not smoking in the previous seven days based on self-report using the TLFB method and confirmed with a Carbon Monoxide (CO) level \<8 ppm.

Outcome measures

Outcome measures
Measure
Osmotic-Release Methylphenidate (OROS-MPH)
n=38 Participants
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo
n=42 Participants
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH)-Week 11
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo-Week 11
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Release Methylphenidate (OROS-MPH)-Week 4
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo-Week 4
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Release Methylphenidate (OROS-MPH)-Week 7
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo-Week 7
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Release Methylphenidate (OROS-MPH)-Week 9
OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Methylphenidate (OROS-MPH) - Placebo-Week 9
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Point-prevalence Abstinence
24 participants
26 participants

Adverse Events

Osmotic-Release Methylphenidate (OROS-MPH)

Serious events: 2 serious events
Other events: 35 other events
Deaths: 0 deaths

Osmotic-Release Methylphenidate (OROS-MPH) - Placebo

Serious events: 0 serious events
Other events: 28 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Osmotic-Release Methylphenidate (OROS-MPH)
n=127 participants at risk
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo
n=128 participants at risk
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Injury, poisoning and procedural complications
Road Traffic Accident
0.79%
1/127 • Number of events 1
0.00%
0/128
Psychiatric disorders
Depression
0.79%
1/127 • Number of events 1
0.00%
0/128

Other adverse events

Other adverse events
Measure
Osmotic-Release Methylphenidate (OROS-MPH)
n=127 participants at risk
For OROS-MPH, the starting dose of 18 mg/day was escalated during the first two study weeks to a maximum of 72 mg/day or to the highest dose tolerated. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Osmotic-Release Methylphenidate (OROS-MPH) - Placebo
n=128 participants at risk
OROS-MPH/placebo was taken through the week 11 visit. A trained interventionist provided each participant with a weekly 10 minute smoking cessation counseling session during study weeks 1-11. All participants received transdermal nicotine patches.
Nervous system disorders
Headache
27.6%
35/127 • Number of events 35
21.9%
28/128 • Number of events 28
Psychiatric disorders
Nervousness
22.0%
28/127 • Number of events 28
16.4%
21/128 • Number of events 21
Psychiatric disorders
Anxiety
18.9%
24/127 • Number of events 24
14.1%
18/128 • Number of events 18
Psychiatric disorders
Insomnia
17.3%
22/127 • Number of events 22
13.3%
17/128 • Number of events 17
Infections and infestations
Nasopharyngitis
15.7%
20/127 • Number of events 20
10.9%
14/128 • Number of events 14
Metabolism and nutrition disorders
Decreased Appetite
18.1%
23/127 • Number of events 23
5.5%
7/128 • Number of events 7
Gastrointestinal disorders
Nausea
14.2%
18/127 • Number of events 18
7.8%
10/128 • Number of events 10
Gastrointestinal disorders
Dry Mouth
11.8%
15/127 • Number of events 15
5.5%
7/128 • Number of events 7
Psychiatric disorders
Abnormal Dreams
7.1%
9/127 • Number of events 9
7.0%
9/128 • Number of events 9
Infections and infestations
Upper Respiratory Tract Infection
5.5%
7/127 • Number of events 7
7.8%
10/128 • Number of events 10
Respiratory, thoracic and mediastinal disorders
Cough
8.7%
11/127 • Number of events 11
4.7%
6/128 • Number of events 6
Skin and subcutaneous tissue disorders
Rash
7.9%
10/127 • Number of events 10
3.1%
4/128 • Number of events 4
Psychiatric disorders
Initial Insomnia
7.1%
9/127 • Number of events 9
3.9%
5/128 • Number of events 5
Musculoskeletal and connective tissue disorders
Back Pain
5.5%
7/127 • Number of events 7
4.7%
6/128 • Number of events 6
Nervous system disorders
Dizziness
6.3%
8/127 • Number of events 8
3.9%
5/128 • Number of events 5
Respiratory, thoracic and mediastinal disorders
Sinus Congestion
3.9%
5/127 • Number of events 5
5.5%
7/128 • Number of events 7
Gastrointestinal disorders
Toothache
3.9%
5/127 • Number of events 5
4.7%
6/128 • Number of events 6
Psychiatric disorders
Stress
3.9%
5/127 • Number of events 5
4.7%
6/128 • Number of events 6
Psychiatric disorders
Agitation
3.9%
5/127 • Number of events 5
3.9%
5/128 • Number of events 5
Psychiatric disorders
Sleep Disorder
3.9%
5/127 • Number of events 5
3.9%
5/128 • Number of events 5
Nervous system disorders
Psychomotor Hyperactivity
7.1%
9/127 • Number of events 9
0.78%
1/128 • Number of events 1
Gastrointestinal disorders
Dyspepsia
7.1%
9/127 • Number of events 9
0.78%
1/128 • Number of events 1
Musculoskeletal and connective tissue disorders
Pain in Extremity
3.1%
4/127 • Number of events 4
4.7%
6/128 • Number of events 6
Investigations
Heart Rate Increased
7.1%
9/127 • Number of events 9
0.78%
1/128 • Number of events 1
Cardiac disorders
Palpitations
7.1%
9/127 • Number of events 9
0.78%
1/128 • Number of events 1
Psychiatric disorders
Depressed Mood
2.4%
3/127 • Number of events 3
4.7%
6/128 • Number of events 6
Skin and subcutaneous tissue disorders
Application Site Pruritus
3.9%
5/127 • Number of events 5
3.1%
4/128 • Number of events 4
Musculoskeletal and connective tissue disorders
Musculoskeletal Pain
5.5%
7/127 • Number of events 7
1.6%
2/128 • Number of events 2
Respiratory, thoracic and mediastinal disorders
Nasal Congestion
2.4%
3/127 • Number of events 3
4.7%
6/128 • Number of events 6
General disorders
Dysgeusia
3.1%
4/127 • Number of events 4
3.1%
4/128 • Number of events 4
Gastrointestinal disorders
Vomiting
4.7%
6/127 • Number of events 6
1.6%
2/128 • Number of events 2
General disorders
Arthalagia
3.1%
4/127 • Number of events 4
3.1%
4/128 • Number of events 4
General disorders
Fatigue
11.8%
15/127 • Number of events 15
9.4%
12/128 • Number of events 12
Psychiatric disorders
Depression
5.5%
7/127 • Number of events 7
1.6%
2/128 • Number of events 2

Additional Information

Dr. Theresa Winhusen

University of CIncinnati

Phone: 513-487-7800

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place