New York State Psychiatric Institute, 1051 Riverside Drive, Unit 51, Room 3717, New York, NY 10032
J Clin Psychiatry. 2013 Oct;74(10):983-90. doi: 10.4088/JCP.12m08155.
To determine whether treatment of attention-deficit/hyperactivity disorder (ADHD) with osmotic-release oral system (OROS) methylphenidate promotes abstinence from smoking among smokers with ADHD who have greater severity of ADHD symptoms at baseline or greater improvement in ADHD during treatment.
This is a secondary analysis of data from a randomized, double-blind, 11-week trial conducted between December 2005 and January 2008 at 6 clinical sites; the original trial was sponsored by the National Drug Abuse Clinical Trials Network. Adult cigarette smokers (aged 18-55 years) who met DSM-IV criteria for ADHD were randomly assigned to OROS methylphenidate (72 mg/d) (n = 127) or matching placebo (n = 128). All participants received nicotine patches (21 mg/d) and weekly individual smoking cessation counseling. Logistic regression was used to model prolonged abstinence from smoking (ascertained by self-report and breath carbon monoxide testing) as a function of treatment, baseline ADHD Rating Scale-IV (ADHD-RS) score, change in ADHD-RS score during treatment, and their interactions.
Treatment interacted with both ADHD-RS score at baseline (P = .01) and change in ADHD-RS score during treatment (P = .008). Among patients with higher ADHD-RS scores (> 36) at baseline and the most improvement in ADHD during treatment (ADHD-RS change score ≥ 24), 70.0% of those who took OROS methylphenidate achieved abstinence from smoking compared to 36.8% of those who took placebo (P = .02). In contrast, among patients with the lowest ADHD-RS baseline scores (≤ 30), 30.3% of those who took OROS methylphenidate achieved abstinence from smoking compared to 60.7% of those who took placebo (P = .02).
OROS methylphenidate, in combination with nicotine patch, may be an effective treatment for nicotine dependence among smokers with more severe ADHD and more robust response of ADHD symptoms to medication. OROS methylphenidate may be counterproductive among smokers with lower severity of ADHD.
ClinicalTrials.gov identifier: NCT00253747.
确定治疗注意缺陷多动障碍（ADHD）的渗透型控释口服制剂（OROS）哌甲酯是否能促进基线时 ADHD 症状更严重或治疗期间 ADHD 症状改善更明显的 ADHD 吸烟者戒烟。
这是一项 2005 年 12 月至 2008 年 1 月在 6 个临床地点进行的随机、双盲、为期 11 周的试验的二次分析；该原始试验由国家药物滥用临床试验网络资助。符合 DSM-IV 中 ADHD 标准的成年吸烟人群（年龄 18-55 岁）被随机分配至 OROS 哌甲酯（72mg/d）组（n=127）或匹配安慰剂组（n=128）。所有参与者均接受尼古丁贴片（21mg/d）和每周一次的个体戒烟咨询。采用逻辑回归模型，将通过自我报告和呼气一氧化碳测试确定的延长戒烟时间（持续时间）作为治疗、基线 ADHD 评定量表-IV（ADHD-RS）评分、治疗期间 ADHD-RS 评分变化的函数，并分析它们之间的相互作用。
治疗与基线时的 ADHD-RS 评分（P=0.01）和治疗期间 ADHD-RS 评分变化（P=0.008）均存在交互作用。在基线时 ADHD-RS 评分较高（>36）且治疗期间 ADHD 改善最大（ADHD-RS 评分变化≥24）的患者中，接受 OROS 哌甲酯治疗的患者中有 70.0%戒烟，而接受安慰剂治疗的患者中仅有 36.8%戒烟（P=0.02）。相比之下，在基线时 ADHD-RS 评分最低（≤30）的患者中，接受 OROS 哌甲酯治疗的患者中有 30.3%戒烟，而接受安慰剂治疗的患者中有 60.7%戒烟（P=0.02）。
OROS 哌甲酯联合尼古丁贴片可能是治疗 ADHD 症状更严重且对药物治疗反应更明显的 ADHD 吸烟者尼古丁依赖的有效方法。OROS 哌甲酯可能对 ADHD 严重程度较低的吸烟者产生不利影响。
ClinicalTrials.gov 标识符：NCT00253747。
