Lam, Alexandra P., Matthies, Swantje, Graf, Erika, Colla, Michael, Jacob, Christian, Sobanski, Esther, Alm, Barbara, Roesler, Michael, Retz, Wolfgang ORCID: 0000-0002-8582-3414, Retz-Junginger, Petra, Kis, Bernhard, Abdel-Hamid, Mona, Mueller, Helge H. O., Luecke, Caroline, Huss, Michael, Jans, Thomas, Berger, Mathias, van Elst, Ludger Tebartz, Philipsen, Alexandra, Heuser, Isabella, Colla, Michael, Gentschow, Laura, Kunze, Paula, Langner, Daina, Lam, Alexandra, Wiltfang, Jens, Kis, Bernhard, Abdel-Hamid, Mona, Heinrich, Viola, Kraemer, Markus, Uekermann, Jennifer, Philipsen, Alexandra, Graf, Erika, Matthies, Swantje, Loewer, Marc, Borel, Patricia, Jansen, Imke, Bonfico, Steffi, Joossens, Manuel, Sadohara, Chiharu, Weber, Manfred, Kamp, Melanie, Dopatka, Tatja, Perlov, Evgeniy, Richter, Harald, Roesler, Michael, Retz, Wolfgang ORCID: 0000-0002-8582-3414, Retz-Junginger, Petra, Roemer, Konstanze, Leipnitz, Birgit, Doyran, Sabine, Schulte-Altedorneburg, Monika, Carl, Christine, Keutler, Clemens, Huss, Michael, Kornmann, Catherine, Buerger, Arne, Chervenkova, Galina, Meinhardt, Patricia, Meyer-Lindenberg, Andreas, Sobanski, Esther, Alm, Barbara, Schumacher-Stien, Martina, Bukow, Simon, Argiriou-Martin, Sotiria, Deckert, Juergen, Warnke, Andreas, Jacob, Christian, Jans, Thomas, Gross-Lesch, Silke, Heine, Monika, Boreatti-Huemmer, Andrea, Heupel, Julia, Reichert, Susanne, Mueller, Sabine, Kreiker, Susanne, Gessner, Alexandra, Conzelmann, Annette, Baehne, Christina, Bredenkamp, Rainer, Ihorst, Gabriele, Graf, Erika, Remschmidt, Helmut, Wassmer, Gernot, Wodarz, Norbert, Frank, Ulrike, Mayer-Bruns, Friederike, 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 Netw. Open, 2 (5). CHICAGO: AMER MEDICAL ASSOC. ISSN 2574-3805

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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: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Lam, Alexandra P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Matthies, SwantjeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Graf, ErikaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Colla, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jacob, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sobanski, EstherUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Alm, BarbaraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Roesler, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Retz, WolfgangUNSPECIFIEDorcid.org/0000-0002-8582-3414UNSPECIFIED
Retz-Junginger, PetraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kis, BernhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Abdel-Hamid, MonaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mueller, Helge H. O.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Luecke, CarolineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Huss, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jans, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Berger, MathiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Elst, Ludger TebartzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Philipsen, AlexandraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heuser, IsabellaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Colla, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gentschow, LauraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kunze, PaulaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Langner, DainaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lam, AlexandraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wiltfang, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kis, BernhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Abdel-Hamid, MonaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heinrich, ViolaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kraemer, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Uekermann, JenniferUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Philipsen, AlexandraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Graf, ErikaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Matthies, SwantjeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Loewer, MarcUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Borel, PatriciaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jansen, ImkeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bonfico, SteffiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Joossens, ManuelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sadohara, ChiharuUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weber, ManfredUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kamp, MelanieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dopatka, TatjaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Perlov, EvgeniyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Richter, HaraldUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Roesler, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Retz, WolfgangUNSPECIFIEDorcid.org/0000-0002-8582-3414UNSPECIFIED
Retz-Junginger, PetraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Roemer, KonstanzeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Leipnitz, BirgitUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Doyran, SabineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schulte-Altedorneburg, MonikaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Carl, ChristineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Keutler, ClemensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Huss, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kornmann, CatherineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Buerger, ArneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chervenkova, GalinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meinhardt, PatriciaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meyer-Lindenberg, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sobanski, EstherUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Alm, BarbaraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schumacher-Stien, MartinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bukow, SimonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Argiriou-Martin, SotiriaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Deckert, JuergenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Warnke, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jacob, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jans, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gross-Lesch, SilkeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heine, MonikaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boreatti-Huemmer, AndreaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heupel, JuliaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reichert, SusanneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mueller, SabineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kreiker, SusanneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gessner, AlexandraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Conzelmann, AnnetteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baehne, ChristinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bredenkamp, RainerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ihorst, GabrieleUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Graf, ErikaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Remschmidt, HelmutUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wassmer, GernotUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wodarz, NorbertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Frank, UlrikeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mayer-Bruns, FriederikeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schehr, KirstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schlander, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-148769
DOI: 10.1001/jamanetworkopen.2019.4980
Journal or Publication Title: JAMA Netw. Open
Volume: 2
Number: 5
Date: 2019
Publisher: AMER MEDICAL ASSOC
Place of Publication: CHICAGO
ISSN: 2574-3805
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
DEFICIT HYPERACTIVITY DISORDER; COGNITIVE-BEHAVIORAL THERAPY; MEDICATION-TREATED ADULTS; METHYLPHENIDATE TREATMENT; GERMAN VALIDATION; DOUBLE-BLIND; ADHD; DOPAMINE; CHILDREN; PLACEBOMultiple languages
Medicine, General & InternalMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/14876

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