The study compared 12-month persistence of methylphenidate (MPH) and dexamphetamine (dAMP) in 12,995 adults with ADHD, 49% female. Persistence was time to switching stimulant class, starting a non-stimulant, or discontinuing, modelled with mixed-effects Cox regression. Median time-to-transition was 33.1 weeks for dAMP and 15.0 weeks for MPH. MPH had a 45% higher hazard of non-persistence (HR 1.45, 95% CI 1.36-1.55). Hyperactive/impulsive presentation and objective impulsivity predicted earlier transition (HR 1.14 and 1.05). The advantage of dAMP grew with higher objective hyperactivity (interaction HR 1.09); treatment was not randomised.
Why it is interesting: Persistence differs by more than twofold in median duration between two first-line stimulants in the same cohort. Objectively measured activity and impulsivity identify who stops earliest.
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