Periodic Reporting for period 1 - TIMESPAN (Management of chronic cardiometabolic disease and treatment discontinuity in adult ADHD patients)
Periodo di rendicontazione: 2021-04-01 al 2022-09-30
Emerging evidence points at substantial comorbidity adult Attention Deficit Hyperactivity Disorders (ADHD) and cardiometabolic diseases (i.e. Obesity, Type-2 Diabetes and cardiovascular disease). National guidelines of cardiometabolic disease have stressed the importance of co-occurring psychiatric disorders. However, even though ADHD is a common and serious condition, knowledge about appropriate management of adults with ADHD and co-occurring cardiometabolic disease is lacking.
Our specific objectives are:
1: Determine if ADHD in adults worsens prognosis and hampers the management of cardiometabolic disease
2: Identify the cardiometabolic risks and benefits of multidisciplinary treatment approaches in patients with ADHD
3. Identify reasons for ADHD treatment discontinuity in adult patients with and without cardiometabolic disease
4. Identify patients with ADHD at high-risk for poor cardiometabolic outcomes and treatment discontinuity
5: Provide an ethical strategy and (FAIR) data management plan (DMP) to allow for maximal transparency, open access/science, usability and reproducibility
6: Broadly disseminate the TIMESPAN findings amongst stakeholders (from patients to health authorities) and provide guidelines for the clinical management of adults with ADHD and co-occurring cardiometabolic disease
7: Train scientists, clinicians and a new generation of interdisciplinary researchers
Our specific objectives are:
1: Determine if ADHD in adults worsens prognosis and hampers the management of cardiometabolic disease
2: Identify the cardiometabolic risks and benefits of multidisciplinary treatment approaches in patients with ADHD
3. Identify reasons for ADHD treatment discontinuity in adult patients with and without cardiometabolic disease
4. Identify patients with ADHD at high-risk for poor cardiometabolic outcomes and treatment discontinuity
5: Provide an ethical strategy and (FAIR) data management plan (DMP) to allow for maximal transparency, open access/science, usability and reproducibility
6: Broadly disseminate the TIMESPAN findings amongst stakeholders (from patients to health authorities) and provide guidelines for the clinical management of adults with ADHD and co-occurring cardiometabolic disease
7: Train scientists, clinicians and a new generation of interdisciplinary researchers
Determine if ADHD in adults worsens prognosis and hampers the management of cardiometabolic disease: We have obtained data access for the register data from almost all countries and produced harmonized definitions across countries. We have developed a plan for how to analyse this data in consistent way across all countries. We are working on four projects in parallel all focusing on about influence of ADHD on medication adherence of cardiometabolic disease. We have already published several manuscripts.
Identify the cardiometabolic risks and benefits of multidisciplinary treatment approaches in patients with ADHD: We have obtained data access for the register data from almost all countries and produced harmonized definitions across countries. We have developed a plan for how to analyse this data in consistent way across all countries. We are working on five projects in parallel all focusing on cardiometabolic risks and benefits of treatment. We have also published study findings. We have prepared for a data collection that will acquire real-world data using novel Remote Measurement Technology including both active and passive monitoring to capture real-time disease processes, including aspects of ADHD medication treatment, physical activity and cardiometabolic risks simultaneously.
Identify reasons for ADHD treatment discontinuity in adult patients with and without cardiometabolic disease: We have obtained data access for the register data from almost all countries and produced harmonized definitions across countries. We have estimated the expected treatment length of each medication dispensation using a validated machine-learning algorithm. We have developed a plan for how to analyse this data in consistent way across all countries. We have also analysed how genetic factors influence ADHD medication discontinuity. We have prepared a data collection using Remote Measurement Technology that will allow us to identify predictors and correlates of adult ADHD medication treatment discontinuity.
Identify patients with ADHD at high-risk for poor cardiometabolic outcomes and treatment discontinuity: we have developed the relevant machine learning and deep learning models and shared codes in public repositories. We are now applying these models in large scale real-world datasets, optimizing the model performance in these datasets and evaluating the generalizability to reserved unseen data, or datasets from different cohorts. Our goal is to develop generalizable risk stratification tools that will be especially useful in primary care settings where ADHD itself, as well as its comorbidity with cardiometabolic disease is typically under identified in adults.
Provide an ethical strategy and a FAIR DMP to allow for maximal transparency, open access/science, usability and reproducibility: We have formed an Ethics and Data Management board as well as a Data Management Advisory Committee. We have overseen adherence to all existing ethical and safety provisions and we have also developed a DMP. Furthermore, we have overseen all ethics approval documents for all sites involved in newly recruiting patients. In addition, we have also overseen the collection of all approvals from the existing cohorts that are used in TIMESPAN. We have also supervised and implemented the common protocols and distributed network approach.
Broadly disseminate the TIMESPAN findings amongst stakeholders and provide guidelines for the clinical management of adults with ADHD and co-occurring cardiometabolic disease: We have developed the TIMESPAN website and implemented social media channels. We released a project brochure with the relevant information of the project and also created a roll-up poster to increase the visibility of the project. During this period different manuscripts were submitted for publication as open access international journals (BMC psychiatrist). We have submitted systematic review/meta-analysis covering ADHD medication and cardiometabolic disease, which will be part of the future recommendations and guidelines implemented by the project.
Train scientists, clinicians and a new generation of interdisciplinary researchers: We have established a mentor mentee program within TIMESPAN. Each ECRs have a mentor from another site within TIMESPAN. TIMESPAN ECRs developed personal portfolios specifying their personal training objectives and needs. We have organized a masterclass for ECRs during our annual meeting.
Identify the cardiometabolic risks and benefits of multidisciplinary treatment approaches in patients with ADHD: We have obtained data access for the register data from almost all countries and produced harmonized definitions across countries. We have developed a plan for how to analyse this data in consistent way across all countries. We are working on five projects in parallel all focusing on cardiometabolic risks and benefits of treatment. We have also published study findings. We have prepared for a data collection that will acquire real-world data using novel Remote Measurement Technology including both active and passive monitoring to capture real-time disease processes, including aspects of ADHD medication treatment, physical activity and cardiometabolic risks simultaneously.
Identify reasons for ADHD treatment discontinuity in adult patients with and without cardiometabolic disease: We have obtained data access for the register data from almost all countries and produced harmonized definitions across countries. We have estimated the expected treatment length of each medication dispensation using a validated machine-learning algorithm. We have developed a plan for how to analyse this data in consistent way across all countries. We have also analysed how genetic factors influence ADHD medication discontinuity. We have prepared a data collection using Remote Measurement Technology that will allow us to identify predictors and correlates of adult ADHD medication treatment discontinuity.
Identify patients with ADHD at high-risk for poor cardiometabolic outcomes and treatment discontinuity: we have developed the relevant machine learning and deep learning models and shared codes in public repositories. We are now applying these models in large scale real-world datasets, optimizing the model performance in these datasets and evaluating the generalizability to reserved unseen data, or datasets from different cohorts. Our goal is to develop generalizable risk stratification tools that will be especially useful in primary care settings where ADHD itself, as well as its comorbidity with cardiometabolic disease is typically under identified in adults.
Provide an ethical strategy and a FAIR DMP to allow for maximal transparency, open access/science, usability and reproducibility: We have formed an Ethics and Data Management board as well as a Data Management Advisory Committee. We have overseen adherence to all existing ethical and safety provisions and we have also developed a DMP. Furthermore, we have overseen all ethics approval documents for all sites involved in newly recruiting patients. In addition, we have also overseen the collection of all approvals from the existing cohorts that are used in TIMESPAN. We have also supervised and implemented the common protocols and distributed network approach.
Broadly disseminate the TIMESPAN findings amongst stakeholders and provide guidelines for the clinical management of adults with ADHD and co-occurring cardiometabolic disease: We have developed the TIMESPAN website and implemented social media channels. We released a project brochure with the relevant information of the project and also created a roll-up poster to increase the visibility of the project. During this period different manuscripts were submitted for publication as open access international journals (BMC psychiatrist). We have submitted systematic review/meta-analysis covering ADHD medication and cardiometabolic disease, which will be part of the future recommendations and guidelines implemented by the project.
Train scientists, clinicians and a new generation of interdisciplinary researchers: We have established a mentor mentee program within TIMESPAN. Each ECRs have a mentor from another site within TIMESPAN. TIMESPAN ECRs developed personal portfolios specifying their personal training objectives and needs. We have organized a masterclass for ECRs during our annual meeting.
TIMESPAN is expected to improve the clinical outcomes, as well as quality of life in adult ADHD patients with co-occurring cardiometabolic disease and also to also facilitates developments of new technological tools for advanced data management, monitoring and analytics for European stakeholders. TIMESPAN strategies to inform clinicians, patients, health authorities, and general public allow for a sustainable implementation of our findings
While most TIMESPAN projects are ongoing, we are already active in preparing to create societal impact. In particular, we have already submitted three systematic reviews and meta-analysis and we have published several important findings regarding the association between ADHD and cardiometabolic disease. We have introduced these findings to the scientific community, patients, and the wider public.
While most TIMESPAN projects are ongoing, we are already active in preparing to create societal impact. In particular, we have already submitted three systematic reviews and meta-analysis and we have published several important findings regarding the association between ADHD and cardiometabolic disease. We have introduced these findings to the scientific community, patients, and the wider public.