Betts Keith A, Sikirica Vanja, Hodgkins Paul, Zhou Zhou, Xie Jipan, DeLeon Anthony, Erder M Haim, Wu Eric Q
1 Analysis Group Inc. , Boston, Massachusetts.
J Child Adolesc Psychopharmacol. 2014 Jun;24(5):260-8. doi: 10.1089/cap.2013.0107. Epub 2014 May 19.
Stimulants are recommended as a first-line treatment for attention- deficit/hyperactivity disorder (ADHD); however, a subset of the patient population augments their stimulant treatment with other medications. The objective of this study was to estimate the 1 year period prevalence of concomitant psychotropic medication use among children and adolescents with ADHD during 2009.
Patients 6-17 years of age with one or more primary ADHD diagnoses between July 1, 2008 and December 31, 2009 and one or more stimulant prescription fills during 2009 were identified from a large United States commercial claims database. Concomitant psychotropic medication use, defined as 30 days of continuous medication supply overlap between the augmenting agent and stimulant, was evaluated for 14 distinct psychotropic medication categories (6 with a United States Food and Drug Administration (FDA) approved indication for ADHD, 8 without an indication for ADHD). The 1 year period prevalence of concomitant psychotropic medication use (both overall and within each medication category) was calculated and compared between patients with and without psychiatric or neurologic comorbidities. Children (6-12 years) and adolescents (13-17 years) were evaluated separately.
A total of 71,201 children and 49,959 adolescents met the inclusion criteria. The 1 year period prevalence of concomitant psychotropic medication use among children and adolescents was 20.3% and 23.4%, with 5.7% and 6.7% augmenting with two or more medication categories, respectively. The most common concomitant medication categories were selective serotonin reuptake inhibitors (SSRIs) (children: 6.2%; adolescents: 11.4%), atypical antipsychotics (5.8%; 6.8%) and clonidine immediate release (5.4%; 2.9%). Children and adolescents with psychiatric or neurologic comorbidities had higher rates of augmentation than did those without comorbidities (all p<0.001).
This epidemiologic study found that the prevalence of concomitant psychotropic medication use in children and adolescents ranged from 12.6% for noncomorbid ADHD to 41.7% for comorbid ADHD, in 2009. Future research is warranted to evaluate the rationale for, and clinical benefit of, concomitant psychotropic medication usage in patients with ADHD.
兴奋剂被推荐作为治疗注意力缺陷/多动障碍（ADHD）的一线药物；然而，有一部分患者会用其他药物辅助其兴奋剂治疗。本研究的目的是估计2009年患有ADHD的儿童和青少年中同时使用精神类药物的1年期间患病率。
从一个大型美国商业索赔数据库中识别出在2008年7月1日至2009年12月31日期间有一项或多项原发性ADHD诊断且在2009年有一次或多次兴奋剂处方配药的6至17岁患者。对14种不同的精神类药物类别评估了同时使用精神类药物的情况，定义为辅助药物与兴奋剂之间有30天的连续药物供应重叠（6种有美国食品药品监督管理局（FDA）批准的ADHD适应症，8种无ADHD适应症）。计算了同时使用精神类药物的1年期间患病率（总体以及各药物类别内），并在有和没有精神或神经共病的患者之间进行比较。分别对儿童（6至12岁）和青少年（13至17岁）进行了评估。
共有71201名儿童和49959名青少年符合纳入标准。儿童和青少年中同时使用精神类药物的1年期间患病率分别为20.3%和23.4%，分别有5.7%和6.7%的患者使用两种或更多药物类别进行辅助治疗。最常见的同时使用的药物类别是选择性5-羟色胺再摄取抑制剂（SSRI）（儿童：6.2%；青少年：11.4%）、非典型抗精神病药物（5.8%；6.8%）和速释可乐定（5.4%；2.9%）。有精神或神经共病的儿童和青少年的辅助治疗率高于无共病的患者（所有p<0.001）。
这项流行病学研究发现，2009年患有ADHD的儿童和青少年中同时使用精神类药物的患病率，无共病的ADHD患者为12.6%，有共病的ADHD患者为41.7%。有必要进行进一步研究，以评估ADHD患者同时使用精神类药物的基本原理和临床益处。
