Evaluate the Safety and Efficacy of Methylphenidate Transdermal System (MTS) in Adolescents Aged 13-17 Years With ADHD

To evaluate the long-term, safety of Methylphenidate Transdermal System (MTS) in the symptomatic treatment of adolescents aged 13-17 years diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria. The evaluation of safety will be based on treatment-emergent adverse events (TEAEs), laboratory tests, vital signs, physical examinations, electrocardiograms (ECGs), and skin tolerability to MTS based on the dermal response score (DRS).

• Methylphenidate Transdermal System (Drug), also known as DAYTRANA: One of 4 doses of the MTS transdermal patch over the same duration of wear for approximately 6 months

Primary outcomes

• Systolic Blood Pressure [Baseline and 6 months]
• Diastolic Blood Pressure [Baseline and 6 months]
• Pulse Rate [Baseline and 6 months]
• Electrocardiogram Results (QTcF Interval) [Baseline and 6 months]: QTcF is the QT interval using Fridericia's correction formula. QT interval is a measure of time between the start of the Q wave and the end of the T wave and is dependent on the heart rate(e.g., the faster the heart rate, the shorter the QT interval). The QT interval has to be corrected in order to aid interpretation.
• Post Sleep Questionnaire (PSQ) Quality of Sleep [6 months]: Post Sleep Questionnaire (PSQ) overall rating of quality of sleep. There are 5 rating responses ranging from very poor to very good. No numbers are associated with the rating responses.
• Weight [Baseline and 6 months]
• Dermal Reactions [6 months]: Dermal reactions were graded on a scale ranging from 0 (no irritation) to 7 (strong reaction) for observed findings of erythema, edema, papules, and vesicles.

Secondary outcomes

• Change From Baseline in Attention Deficit Hyperactivity Disorder Rating Scale-fourth Edition (ADHD-RS-IV) Scores at 6 Months [Baseline and 6 months]: The ADHD-RS-IV consists of 18 items scored on a 4-point scale ranging from 0 (no symptoms) to 3 (severe symptoms) with total score ranging from 0 to 54.
• Change From Baseline in Conner's Parent Rating Scale-revised Short Version (CPRS-R) at 6 Months [Baseline and 6 months]: The Conner's Parent rating Scale-revised short version (CPRS-R) consists of 27 questions graded on a scale from 0 (not true at all) to 3 (very much true) with a total score ranging from 0 to 81. Higher scores are indicative of increased ADHD. This scale allows parents to respond on the basis of the child's behavior and help assess ADHD and evaluate problem behavior.
• Number of Participants With Improvement on Clinical Global Impression-Improvement (CGI-I) Scores [6 months]: Clinical Global Impression-Improvement (CGI-I) consists of a 7-point scale ranging from 1 (very much improved) to 7 (very much worse). Improvement is defined as a score of 1 (very much improved) or 2 (much improved) on the scale.
• Number of Participants With Improvement on Parent Global Assessment (PGA) Scores. [6 months]: Parent Global Assessment (PGA) consists of a 7-point scale ranging from 1 (very much improved) to 7 (very much worse). Improvement is defined as a score of 1 (very much improved) or 2 (much improved) on the scale.
• Change From Baseline in Youth Quality of Life-research Version (YQOL-R) Total Score at 6 Months [Baseline and 6 months]: The Youth Quality of Life-research version (YQOL-R) is a validated 56-item generic instrument for comparing quality of life of adolescents across condition groups that scores each question on a scale from 0 (never) to 4 (very often). The YQOL scores are transformed to a 0-100 scale for easy interpretability. Higher scores indicate better quality of life.

Sex: All, ages: 13 Years to 17 Years

Inclusion Criteria:

To be eligible for inclusion, each subject must fulfill each of the following criteria at the Entry visit:

* The subject participated in the antecedent SPD485-409 study, and a) completed all required study visits (Baseline through Visit 9) OR b) completed the 5 week Dose Optimization period without achieving an acceptable condition as defined by the antecedent SPD485-409 study.
* Subject has blood pressure measurements within the 95th percentile for age, gender, and height at Entry.
* Subject's ECG results are within the normal range or not clinically significant at Entry as judged by the Investigator in conjunction with the central reader.
* Females must have a negative urine pregnancy test at Entry and agree to use acceptable contraceptives throughout the study period and for 30 days the last dose of IP.
* Subject and parent of legally authorized representative (LAR) are able, willing and likely to fully comply with study procedures and restrictions.
* Written, signed and dated informed consent to participate in the study must be given by the subject's parent or LAR, in accordance with the International Conference on Harmonisation (ICH), Good Clinical Practices (GCP) Guideline E6 and applicable regulations, before completing any study-related procedures.
* There must be documentation of the subject's assent to participate in the study indicating that the subject is aware of the investigational nature of the study and the required procedures and restrictions. Failure to object is not to be considered assent.

Exclusion Criteria

Subjects will be excluded from the study if any of the following criteria are met at Entry:

* Subject was discontinued from SPD485-409 due to a protocol violation, non-compliance, AE, or a serious adverse event (SAE).
* Subject has a concurrent chronic or acute illness (such as severe allergic rhinitis or an infectious process requiring antibiotics), disability, or other condition that might confound the results of safety assessments administered in the study or that might increase risk to the subject. Similarly, the subject will be excluded if he or she has any additional condition(s) that in the Investigator's opinion would prohibit the subject from completing the study or would not be in the best interest of the subject. This would include any significant illness or unstable medical condition that could lead to difficulty complying with the protocol. Mild, stable asthma is not exclusionary.
* Subject is taking any medication that is excluded.
* Female subject who is pregnant or lactating.

Participant flow

Outcome results

• Change From Baseline in Attention Deficit Hyperactivity Disorder Rating Scale-fourth Edition (ADHD-RS-IV) Scores at 6 Months (Secondary), Mean, Units on a scale: Antecedent Methylphenidate Transdermal System (MTS) 16.0 +/- 12.00; Antecedent Placebo 27.4 +/- 12.91 (p 0.028)
• Change From Baseline in Conner's Parent Rating Scale-revised Short Version (CPRS-R) at 6 Months (Secondary), Mean, Units on a scale: Antecedent Methylphenidate Transdermal System (MTS) 26.5 +/- 18.22; Antecedent Placebo 42.3 +/- 16.94 (p 0.027)
• Number of Participants With Improvement on Clinical Global Impression-Improvement (CGI-I) Scores (Secondary), Number, Participants: Antecedent Methylphenidate Transdermal System (MTS) 81; Antecedent Placebo 39
• Number of Participants With Improvement on Parent Global Assessment (PGA) Scores. (Secondary), Number, Participants: Antecedent Methylphenidate Transdermal System (MTS) 69; Antecedent Placebo 31
• Change From Baseline in Youth Quality of Life-research Version (YQOL-R) Total Score at 6 Months (Secondary), Mean, Units on a scale: Antecedent Methylphenidate Transdermal System (MTS) 82.4 +/- 14.28; Antecedent Placebo 80.9 +/- 14.61 (p 0.071)
• Systolic Blood Pressure (Primary), Mean, mmHg: Antecedent Methylphenidate Transdermal System (MTS) 113.4 +/- 9.59; Antecedent Placebo 113.0 +/- 11.20
• Diastolic Blood Pressure (Primary), Mean, mmHg: Antecedent Methylphenidate Transdermal System (MTS) 69.4 +/- 7.42; Antecedent Placebo 67.2 +/- 7.69
• Pulse Rate (Primary), Mean, beats per minute: Antecedent Methylphenidate Transdermal System (MTS) 80.4 +/- 11.34; Antecedent Placebo 74.3 +/- 9.73
• Electrocardiogram Results (QTcF Interval) (Primary), Mean, msec: Antecedent Methylphenidate Transdermal System (MTS) 391.8 +/- 20.76; Antecedent Placebo 393.2 +/- 17.85
• Post Sleep Questionnaire (PSQ) Quality of Sleep (Primary), Number, Participants: Antecedent Methylphenidate Transdermal System (MTS) 1; Antecedent Placebo 1
• Weight (Primary), Mean, lb: Antecedent Methylphenidate Transdermal System (MTS) 127.05 +/- 24.003; Antecedent Placebo 131.95 +/- 29.862
• Dermal Reactions (Primary), Number, Participants: Antecedent MTS and Antecedent Placebo 23

Adverse events

Serious adverse events by term

Other adverse events by term

• Results publication: Findling RL, Katic A, Rubin R, Moon E, Civil R, Li Y. A 6-month, open-label, extension study of the tolerability and effectiveness of the methylphenidate transdermal system in adolescents diagnosed with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2010 Oct;20(5):365-75. doi: 10.1089/cap.2009.0122. PMID 20973707

• Robert L. Findling, M.D., Principal investigator, University Hospitals Cleveland Medical Center