Kemner Jason E, Lage Maureen J
McNeil Consumer and Specialty Pharmaceuticals, Fort Washington PA 19034, USA.
Ann Gen Psychiatry. 2006 Apr 10;5:5. doi: 10.1186/1744-859X-5-5.
While stimulant therapy has been shown to be effective in the treatment of attention-deficit/hyperactivity disorder (ADHD), there is less information concerning differences between alternative stimulant medications. The purpose of this study is to examine how different formulations of methylphenidate (MPH) affect treatment patterns and hospitalizations.
From a large claims database we retrospectively identified individuals age 6 or older who were diagnosed with ADHD and who received either once daily, extended-release oral system methylphenidate (OROS MPH) (e.g., Concerta) or three-times daily immediate-release generic methylphenidate (TID MPH). There were 5,939 individuals included in the analysis--4,785 who initiated therapy with OROS MPH and 1,154 who initiated therapy with TID MPH. We used Analyses of Covariance (ANCOVAs) to examine differences in treatment patterns between individuals who initiated therapy on OROS MPH and those who initiated therapy on TID MPH. We used logistic and negative binomial multivariate regressions to examine the probability of being hospitalized and the hospital length of stay.
Controlling for demographic characteristics, patient general health status, and comorbid diagnoses, significantly fewer individuals who initiated therapy with OROS MPH had a 15-day gap in therapy (85% vs. 97%, p < 0.0001 or a 30-day gap in therapy (77% vs. 95%, p < 0.0001) or switched to another ADHD medication (27% vs. 68%, p < 0.0001). Individuals who initiated therapy with OROS MPH stayed on therapy significantly longer (199 vs. 108 mean days, p < 0.0001) and more individuals received medication for 90% (24% vs. 5%, p < 0.0001), 80% (29% vs. 7%, p < 0.0001), or 75% (30% vs. 7%, p < 0.0001) of the days during the first year post initiation of therapy. Individuals who initiated therapy on OROS MPH were also significantly less likely to be hospitalized (odds ratio = 0.67, p = 0.0454) and stayed, on average, 0.69 fewer days in the hospital (p = 0.0035).
Results demonstrate that among individuals diagnosed with ADHD who receive either OROS MPH or TID MPH, the use of OROS MPH is associated with fewer gaps in medication, less switches in medication, and more days on intent-to-treat therapy. In addition, use of OROS MPH compared to TID MPH was associated with improved outcomes, as measured by the reduced use of hospitalizations.
虽然兴奋剂疗法已被证明对治疗注意力缺陷多动障碍（ADHD）有效，但关于替代兴奋剂药物之间差异的信息较少。本研究的目的是探讨不同剂型的哌甲酯（MPH）如何影响治疗模式和住院情况。
从一个大型索赔数据库中，我们回顾性地确定了6岁及以上被诊断为ADHD且接受过每日一次缓释口服系统哌甲酯（OROS MPH）（如康纳达）或每日三次速释普通哌甲酯（TID MPH）治疗的个体。分析纳入了5939名个体——4785名开始使用OROS MPH治疗的个体和1154名开始使用TID MPH治疗的个体。我们使用协方差分析（ANCOVAs）来检验开始使用OROS MPH治疗的个体与开始使用TID MPH治疗的个体在治疗模式上的差异。我们使用逻辑回归和负二项式多元回归来检验住院概率和住院时间。
在控制了人口统计学特征、患者总体健康状况和共病诊断后，开始使用OROS MPH治疗的个体出现15天治疗中断的比例显著更低（85%对97%，p<0.0001）或30天治疗中断的比例显著更低（77%对95%，p<0.0001），或换用另一种ADHD药物的比例显著更低（27%对68%，p<0.0001）。开始使用OROS MPH治疗的个体持续治疗的时间显著更长（平均199天对108天，p<0.0001），并且更多个体在治疗开始后的第一年中有90%（24%对5%，p<0.0001）、80%（29%对7%，p<0.0001）或75%（30%对7%，p<0.0001）的天数接受药物治疗。开始使用OROS MPH治疗的个体住院的可能性也显著更低（优势比=0.67，p=0.0454），并且平均住院天数少0.69天（p=0.0035）。
结果表明，在被诊断为ADHD且接受OROS MPH或TID MPH治疗的个体中，使用OROS MPH与用药中断更少、用药更换更少以及意向性治疗天数更多相关。此外，与TID MPH相比，使用OROS MPH与改善的结果相关，这通过住院次数减少来衡量。
