To examine treatment outcomes for classes of ADHD drugs in conjunction with physicians’ prescribing rationales and the utility of treatment perseverance in treatment effectiveness.
Methods:
A retrospective non-interventional study using physician-provided chart data for treated adolescent and adult ADHD patients in the United States (April–June 2019). Multivariable analyses compared the effectiveness and tolerability of drug classes.
Results:
Among the 1,232 ADHD patients included in this study, 37.7% experienced one, 11.8% two, and 6.7% three treatment changes post their first prescribed regimen. These changes were mostly attributed to lack of rapid onset and duration of effect. Achieving best response correlated with the number of previous treatments for adolescents, but not adults. Maintaining full response correlated with the length of current treatment for adolescents and adults.
Conclusion:
Physicians’ prescribing rationales targeted duration of effect and tolerability. ER monotherapy demonstrated potential advantages over other regimens. Treatment perseverance is integral to effective ADHD management.
AshersonP.ManorI.HussM. (2014). Attention-deficit/hyperactivity disorder in adults: Update on clinical presentation and care. Neuropsychiatry, 4(1), 109–128. https://doi.org/10.1177/108705479900300103
2.
BakerM.HuefnerJ. C.BellonciC.HiltR.CarlsonG. A. (2021). Polypharmacy in the management of attention-deficit/hyperactivity disorder in children and adolescents: A review and update. Journal of Child and Adolescent Psychopharmacology, 31(3), 148–163. https://doi.org/10.1089/cap.2020.0162
3.
Cambron-MellottM. J.MiklJ.MatosJ. E.ErensenJ. G.BeusterienK.CataldoM. J.HallisseyB.MattinglyG. W. (2021). Adult patient preferences for long-acting adhd treatments: A discrete choice experiment. Patient Preference and Adherence, 15, 1061–1073. https://doi.org/10.2147/PPA.S311836
ChangZ.QuinnP. D.HurK.GibbonsR. D.SjölanderA.LarssonH.D’OnofrioB. M. (2017). Association between medication use for attention-deficit/hyperactivity disorder and risk of motor vehicle crashes. JAMA Psychiatry, 74(6), 597–603. https://doi.org/10.1001/jamapsychiatry.2017.0659
7.
ChristensenL.SasaneR.HodgkinsP.HarleyC.TetaliS. (2010). Pharmacological treatment patterns among patients with attention-deficit/ hyperactivity disorder: Retrospective claims-based analysis of a managed care population. Current Medical Research and Opinion, 26(4), 977–989. https://doi.org/10.1185/03007991003673617
8.
CorteseS.AdamoN.del GiovaneC.Mohr-JensenC.HayesA. J.CarucciS.AtkinsonL. Z.TessariL.BanaschewskiT.CoghillD.HollisC.SimonoffE.ZuddasA.BarbuiC.PurgatoM.SteinhausenH. C.ShokranehF.XiaJ.CiprianiA. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 5(9), 727–738. https://doi.org/10.1016/S2215-0366(18)30269-4
9.
DoshiJ. A.HodgkinsP.KahleJ.SikiricaV.CangelosiM. J.SetyawanJ.ErderM. H.NeumannP. J. (2012). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10), 990–1002.e2. https://doi.org/10.1016/j.jaac.2012.07.008
10.
EmslieG. J.HughesC. W.CrismonM. L.LopezM.PliszkaS.TopracM. G.BoemerC. (2004). A feasibility study of the childhood depression medication algorithm: The Texas Children’s Medication Algorithm Project (CMAP). Journal of the American Academy of Child and Adolescent Psychiatry, 43(5), 519–527. https://doi.org/10.1097/00004583-200405000-00005
11.
FDA, & Cder. (2021). Highlights of prescribing information. Retrieved December 12, 2021, from https://www.fda.gov/medwatch
12.
GarbeE.MikolajczykR. T.BanaschewskiT.PetermannU.PetermannF.KrautA. A.LangnerI. (2012). Drug treatment patterns of attention-deficit/hyperactivity disorder in children and adolescents in germany: Results from a large population-based cohort study. Journal of Child and Adolescent Psychopharmacology, 22(6), 452–458. https://doi.org/10.1089/cap.2012.0022
13.
GoodheartC. D.LevantR. F.BarlowD. H.CarterJ.DavidsonK. W.HagglundK. J.HollonS. D.JohnsonJ. D.LevitonL. C.MahrerA. R.NewmanF. L.NorcrossJ. C.SilvermanD. K.SmedleyB. D.WampoldB. E.WestenD. I.YatesB. T.ZaneN. W.ReedG. M.. . . BullockM. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271–285. https://doi.org/10.1037/0003-066X.61.4.271
14.
GordonM.AntshelK.FaraoneS.BarkleyR.LewandowskiL.HudziakJ. J.BiedermanJ.CunninghamC.LewandowskiL. (2006). Symptoms versus impairment: The case for respecting DSM-IV’s criterion D. Journal of Attention Disorders, 9(3), 465–475. https://doi.org/10.1177/1087054705283881
15.
KesslerR. C.AdlerL.BerkleyR.BiedermanJ.ConnersC. K.DemlerO.FaraoneS. v.GreenhillL. L.HowesM. J.SecnikK.SpencerT.UstunT. B.WaltersE. E.ZaslavskyA. M. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723. https://doi.org/10.1176/ajp.2006.163.4.716
16.
KooijJ. J. S.BijlengaD.SalernoL.JaeschkeR.BitterI.BalázsJ.ThomeJ.DomG.KasperS.Nunes FilipeC.StesS.MohrP.LeppämäkiS.Casas BruguéM.BobesJ.MccarthyJ. M.RicharteV.Kjems PhilipsenA.PehlivanidisA.. . . AshersonP. (2019). Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56, 14–34. https://doi.org/10.1016/j.eurpsy.2018.11.001
17.
LawsonK. A.JohnsrudM.HodgkinsP.SasanéR.CrismonM. L. (2012). Utilization patterns of stimulants in ADHD in the medicaid population: A retrospective analysis of data from the Texas medicaid program. Clinical Therapeutics, 34(4), 944–956.e4. https://doi.org/10.1016/j.clinthera.2012.02.021
18.
LiangS. H. Y.YangY. H.KuoT. Y.LiaoY. T.LinT. C.LeeY.McIntyreR. S.KelsenB. A.WangT. N.ChenV. C. H. (2018). Suicide risk reduction in youths with attention-deficit/hyperactivity disorder prescribed methylphenidate: A Taiwan nationwide population-based cohort study. Research in Developmental Disabilities, 72, 96–105. https://doi.org/10.1016/j.ridd.2017.10.023
19.
LiaoY. T.YangY. H.KuoT. Y.LiangH. Y.HuangK. Y.WangT. N.LeeY.McIntyreR. S.ChenV. C. H. (2018). Dosage of methylphenidate and traumatic brain injury in ADHD: A population-based study in Taiwan. European Child and Adolescent Psychiatry, 27(3), 279–288. https://doi.org/10.1007/s00787-017-1042-7
20.
LichtensteinP.HalldnerL.ZetterqvistJ.SjölanderA.SerlachiusE.FazelS.LångströmN.LarssonH. (2012). Medication for attention deficit–hyperactivity disorder and criminality. New England Journal of Medicine, 367(21), 2006–2014. https://doi.org/10.1056/nejmoa1203241
21.
LinE.HoP. (2018). Sequenced treatment alternatives to relieve depression: STAR*D. 50 studies every psychiatrist should know. Controlled Clinical Trials, 25, 119–142.
22.
MinkoffN. B. (2009). ADHD in managed care: An assessment of the burden of illness and proposed initiatives to improve outcomes. The American Journal of Managed Care, 15(5), S151–S159.
NylanderE.FlorosO.SpardingT.RydénE.HansenS.LandénM. (2021). Five-year outcomes of ADHD diagnosed in adulthood. Scandinavian Journal of Psychology, 62(1), 13–24. https://doi.org/10.1111/sjop.12692
25.
PetersonK.McDonaghM. S.FuR. (2008). Comparative benefits and harms of competing medications for adults with attention-deficit hyperactivity disorder: A systematic review and indirect comparison meta-analysis. Psychopharmacology, 197(1), 1–11. https://doi.org/10.1007/s00213-007-0996-4
26.
PliszkaS., & AACAP Work Group on Quality Issues. (2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46(7), 894–921. https://doi.org/10.1097/chi.0b013e318054e724
27.
QuinnP. D.ChangZ.HurK.GibbonsR. D.LaheyB. B.RickertM. E.SjölanderA.LichtensteinP.LarssonH.D’OnofrioB. M. (2017). ADHD medication and substance-related problems. American Journal of Psychiatry, 174(9), 877–885. https://doi.org/10.1176/appi.ajp.2017.16060686
28.
RetzW.RöslerM.OseC.ScheragA.AlmB.PhilipsenA.FischerR.AmmerR. (2012). Multiscale assessment of treatment efficacy in adults with ADHD: A randomized placebo-controlled, multi-centre study with extended-release methylphenidate. World Journal of Biological Psychiatry, 13(1), 48–59. https://doi.org/10.3109/15622975.2010.540257
29.
SecnikK.SwensenA.LageM. J. (2005). Comorbidities and costs of adult patients diagnosed with attention-deficit hyperactivity disorder. PharmacoEconomics, 23(1), 93–102. https://doi.org/10.2165/00019053-200523010-00008
30.
SpencerT. J.WilensT. E.BiedermanJ.WeislerR. H.ReadS. C.PrattR. (2006). Efficacy and safety of mixed amphetamine salts extended release (Adderall XR or generic) in the management of attention-deficit/hyperactivity disorder in adolescent patients: A 4-week, randomized, double-blind, placebo-controlled, parallel-group study. Clinical Therapeutics, 28(2), 266–279. https://doi.org/10.1016/j.clinthera.2006.02.011
31.
SteinM. A. (2004). Innovations in attention-deficit/hyperactivity disorder pharmacotherapy: Long-acting stimulant and nonstimulant treatments. American Journal of Managed Care, 10(6), S89–S98.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
