Deborah Brauser

October 09, 2013

BARCELONA, Spain ― Atomoxetine, the selective norepinephrine reuptake inhibitor (SNRI) approved for treating attention-deficit/hyperactivity disorder (ADHD), may provide additional benefits to adult patients, including improved driving skills.

At the 26th European College of Neuropsychopharmacology (ECNP) Congress, lead author Esther Sobanski, MD, from the Department of Psychiatry and Psychotherapy at the Central Institute of Mental Health at the University of Heidelberg in Mannheim, Germany, presented results from a study published recently in European Psychiatry.

The study of 43 adult patients with ADHD showed that those who received daily doses of atomoxetine for 12 weeks had significantly reduced driving errors in the categories of attention, self- control, and driver skills during a standardized, real-traffic test compared with the participants with ADHD who were untreated.

In addition, "self-reported critical traffic situations" decreased significantly at endpoint for the group receiving atomoxetine. And only 18% failed German driving fitness criteria vs 48% of those who did not take the SNRI.

"Studies that go beyond core ADHD symptoms and also investigate the impact of pharmacologic treatment on functional impairment are important," Dr. Sobanski told meeting attendees.

She added that she and her colleagues were interested in the current study because driving is an important aspect of daily living.

"This was the first on-road driving study that was done for this compound in this patient population," she told Medscape Medical News.

Large Untreated Population

During her presentation, Dr. Sobanski noted that the mean prevalence rate for adult ADHD in her country of Germany is approximately 4.7%, whereas the rate in the United States is 4.4%, according to recent epidemiologic studies.

Dr. Esther Sobanski

"However, the diagnostic prevalence of adult ADHD is much lower than the disorder prevalence, with studies showing a rate of below 0.5% in Germany and in Spain," she said.

"And high-quality investigation in the US shows that 90% of adult ADHD currently goes untreated."

As reported at the time by Medscape Medical News, investigators from the University of Massachusetts presented a study at last year's ECNP Congress showing that young people with ADHD between the ages of 18 and 26 years who were given lisdexamfetamine dimesylate had faster reaction/braking time and a lower rate of collisions in a driving simulator than did those who were given placebo.

For the current study, 64 adult outpatients with ADHD between the ages of 18 and 50 years from Mannheim, Germany, were enrolled, with 43 continuing to the end of the 12-week treatment period. Of those who did not drop out, 22 were randomly assigned to receive up to 80 mg/day of atomoxetine (mean daily dosage, 71.6 mg), and 21 were assigned to remain untreated.

All patients were allowed to drive for 1 hour during rush hour in Heidelberg and its surrounding areas at baseline and at endpoint.

At those 2 time points, the participants underwent driving-related neuropsychological performance tests and filled out driving self-evaluation forms. A traffic psychologist also rated driving performance in 4 categories, and the German Evaluation Guidelines of Driving Ability was administered.

Several measures were used to assess ADHD symptoms, including the German-validated Conners' Adult ADHD Rating Scales (CAARS).

Safer Roads

Results showed that significantly more of the atomoxetine-treated patients had a 30% or greater reduction in overall ADHD symptoms on the CAARS than did the untreated patients (60.1% vs 0%).

In addition, the atomoxetine group had significantly reduced errors from baseline to endpoint in 3 of the 4 driving performance categories evaluated. These included driver skills (P < .001), risk-related self-control (P < .005), and attention (P < .05) ― but not orientation.

There were no significant changes in driving performance or number of self-reported critical traffic situations in the untreated group.

However, the group receiving atomoxetine reported a significant weekly drop from 12 to 6.8 of these types of situations (P < .05). Specifically, this included less feeling of being distracted while driving, less driving too fast, and less feeling strained while driving.

"Our study provides first evidence that treatment with [atomoxetine] improves driving performance in real traffic in adults with ADHD," write the researchers. However, they note that future studies are needed that include a placebo-controlled design and a longer observation period.

Dr. Sobanski reported that most of the adult patients who come into her office with untreated ADHD want pharmacologic help because of the many problems they face in their daily lives.

"Driving is just 1 of those areas. And this is an added benefit to treating core ADHD symptoms," she said.

Comparison Studies Needed

"I thought this was good data, although we've seen data with other medications of this type saying the same thing," session moderator Alessandro Zuddas, MD, head of the Center for Pharmacological Therapies in Child and Adolescent Neuropsychiatry at the Cagliari University Hospital in Italy, told Medscape Medical News.

Dr. Alessandro Zuddas

"We've seen this with this type of medication, but it may also happen with medications with different mechanisms. So it would be nice to expand and to see what happens after treatment," he said.

Dr. Zuddas, who was not involved with the research, is also a member of the Scientific Committee of the Italian National Registry of ADHD.

"A symptomatic intervention is very important. And it would be interesting to now see a comparison between these medications in adults to see how each works. Looking at a patient's functioning is the way we should be studying now," he said.

The study was sponsored by Eli Lilly, Germany. The study authors have disclosed several financial relationships, which are listed in the original article.

26th European College of Neuropsychopharmacology (ENCP) Congress. Press briefing given October 7, 2013.

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