Toward personalized smoking-cessation treatment: Using a predictive modeling approach to guide decisions regarding stimulant medication treatment of attention-deficit/hyperactivity disorder (ADHD) in smokers
Year: 2015
Type: article
Abstract: BACKGROUND AND OBJECTIVES: Osmotic-release oral system methylphenidate (OROS-MPH) did not show overall benefit as an adjunct smoking cessation treatment for adult smokers with ADHD in a randomized, placebo-controlled, multicenter clinical trial. A secondary analysis revealed a significant interaction between ADHD symptom severity and treatment-response to OROS-MPH, but did not account for other baseline covariates or estimate the magnitude of improvement in outcome if treatment were optimized. This present study addressed the gaps in how this relationship should inform clinical practice. METHODS: Using data from the Adult Smokers with ADHD Trial (N = 255, six sites in five US States), we build predictive models to calculate the probability of achieving prolonged abstinence, verified by self-report, and expired carbon monoxide measurement. We evaluate the potential improvement in achieving prolonged abstinence with and without stratification on baseline ADHD severity. RESULTS: Predictive modeling demonstrates that the interaction between baseline ADHD severity and treatment group is not affected by adjusting for other baseline covariates. A clinical trial simulation shows that giving OROS-MPH to patients with baseline Adult ADHD Symptom Rating Scale (ADHD-RS) >35 and placebo to those with ADHD-RS ≤35 would significantly improve the prolonged abstinence rate (52 ± 8% vs. 42 ± 5%, p < .001). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: In smokers with ADHD, utilization of a simple decision rule that stratifies patients based on baseline ADHD severity can enhance overall achievement of prolonged smoking abstinence. Similar analysis methods should be considered for future clinical trials for other substance use disorders.
Source: American Journal on Addictions
DOI: 10.1111/ajad.12193
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Drug Abuse Treatment Development and Research Mentoring, Clinical Trials Network, Ohio Valley Node U10DA013732, G6129947497, Substance Abuse Treatment Development and Clinical Research Mentoring, Translational Clinical Research Fellowship on Substance Use Disorders, PRIMING THE PUMP: TRAINING PHYSICIAN-SCIENTISTS IN TRANSLATIONAL PSYCHIATRY, NIDA Clinical Trials Network: New York Node - Renewal-GY24
OpenAlex ID: W2154132892