{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T19:43:05Z","timestamp":1792438985149,"version":"4.5.0"},"reference-count":24,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Psychiatr Scand"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Network meta\u2010analyses suggest dexamphetamines (dAMP) may yield more favourable short\u2010term outcomes than methylphenidate (MPH) in adults with ADHD, yet evidence on long\u2010term comparative persistence remains scarce. This study compared 12\u2010month treatment persistence between MPH and dAMP in a large multicentre cohort and explored associations with ADHD clinical presentations and objectively measured core symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Stimulant persistence was defined by the primary outcome, \u2018time\u2010to\u2010transition\u2019, the interval from initiation to switching stimulant classes, transitioning to non\u2010stimulants or complete discontinuation. Patients were censored at 12\u2009months or at last clinical contact. A multivariable mixed\u2010effects Cox proportional hazard model with a random intercept for clinicians was used to estimate hazard ratios (HR) and assess the relative impact of stimulant class on persistence, including its interactions with DSM\u2010based clinical presentations and objective indices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 12,995 participants (49% female), 62% initiated dAMP and 38% MPH. Median time\u2010to\u2010transition was 33.1\u2009weeks for dAMP versus 15.0\u2009weeks for MPH. MPH was associated with a 45% increased hazard for non\u2010persistence compared to dAMP (HR\u2009=\u20091.45, 95% CI [1.36\u20131.55]). Regarding clinical and objective factors, hyperactive\/impulsive presentation (HR\u2009=\u20091.14,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.025) and objective impulsivity (HR\u2009=\u20091.05,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002) were independently associated with non\u2010persistence. A significant interaction was observed between stimulant class and objective hyperactivity (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), indicating that dAMP's persistence advantage became more pronounced with increasing motor activity (HR\u2009=\u20091.09). Nevertheless, these associations were secondary to the overarching effect of the stimulant class itself.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Treatment with dAMP demonstrates significantly superior 12\u2010month persistence compared to MPH in adults with ADHD. While clinical and objective measures of impulsivity and hyperactivity identify patients at higher risk for treatment non\u2010persistence, dAMP's advantage remains consistent across all presentations. These findings suggest that prioritizing dAMP may enhance long\u2010term treatment persistence in adult ADHD clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acps.70150","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:31:17Z","timestamp":1792063877000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stimulant Persistence in Adult\n                    <scp>ADHD<\/scp>\n                    : A Retrospective Analysis of a Large Clinical Cohort"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6929-4770","authenticated-orcid":false,"given":"R.","family":"Wettstein","sequence":"first","affiliation":[{"name":"Dedimo, Research and Development  Utrecht the Netherlands"},{"name":"Department of Hospital Pharmacy and Clinical Pharmacology Amsterdam University Medical Centre, Location AMC  Amsterdam the Netherlands"},{"name":"ADHDcentraal BV, Specialized Mental Health Centre for Adult ADHD  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4535-7836","authenticated-orcid":false,"given":"E.","family":"Pirgon","sequence":"additional","affiliation":[{"name":"Department of Hospital Pharmacy and Clinical Pharmacology Amsterdam University Medical Centre, Location AMC  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6254-0110","authenticated-orcid":false,"given":"J.","family":"Kroesen","sequence":"additional","affiliation":[{"name":"Dedimo, Research and Development  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2382-2731","authenticated-orcid":false,"given":"V.","family":"Navarro\u2010Ovando","sequence":"additional","affiliation":[{"name":"Department of Hospital Pharmacy and Clinical Pharmacology Amsterdam University Medical Centre, Location AMC  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. C.","family":"Kroesen","sequence":"additional","affiliation":[{"name":"ADHDcentraal BV, Specialized Mental Health Centre for Adult ADHD  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8401-0879","authenticated-orcid":false,"given":"R.","family":"Math\u00f4t","sequence":"additional","affiliation":[{"name":"Department of Hospital Pharmacy and Clinical Pharmacology Amsterdam University Medical Centre, Location AMC  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9973-6901","authenticated-orcid":false,"given":"G.","family":"Dumont","sequence":"additional","affiliation":[{"name":"Dedimo, Research and Development  Utrecht the Netherlands"},{"name":"Department of Hospital Pharmacy and Clinical Pharmacology Amsterdam University Medical Centre, Location AMC  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Canadian ADHD Resource Alliance: Canadian ADHD Practice Guidelines","author":"CADDRA","year":"2020"},{"key":"e_1_2_13_3_1","first-page":"1","volume-title":"Attention Deficit Hyperactivity Disorder: Diagnosis and Management","author":"NICE","year":"2019"},{"key":"e_1_2_13_4_1","unstructured":"Nederlandse Vereniging voor Psychiatrie (NVvP) \u201cRichtlijn ADHD Bij Volwassenen: Diagnostiek en Medicamenteuze Behandeling \u201d2015 1\u2013174 https:\/\/richtlijnendatabase.nl\/richtlijn\/adhd_bij_volwassenen\/adhd_bij_volwassenen_\u2010_startpagina.html."},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2215\u20100366(18)30269\u20104"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0240584"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2215\u20100366(24)00360\u20102"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/acps.13370"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/10870547231177221"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.08.149"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.2147\/ndt.s262995"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/1087054715618788"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1087054716646451"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/1087054720930816"},{"key":"e_1_2_13_16_1","unstructured":"F.Ulberstad \u201cTechnical Manual QbTest \u201d2012 https:\/\/www.QbTech.com."},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3697"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010024\u201005994\u20108"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2021.21010032"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13311\u2010012\u20100135\u20108"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2014.06.003"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.9492"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00213\u2010007\u20100996\u20104"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2015.0060"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/jcp.0b013e3181515205"}],"container-title":["Acta Psychiatrica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acps.70150","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/acps.70150","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acps.70150","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T18:55:30Z","timestamp":1792436130000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acps.70150"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":24,"alternative-id":["10.1111\/acps.70150"],"URL":"https:\/\/doi.org\/10.1111\/acps.70150","archive":["Portico"],"relation":{},"ISSN":["0001-690X","1600-0447"],"issn-type":[{"value":"0001-690X","type":"print"},{"value":"1600-0447","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"assertion":[{"value":"2026-06-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"acps.70150"}}