Zhou Zhou, Zhou Zheng-Yi, Kelkar Sneha S, Sikirica Vanja, Xie Jipan, Grebla Regina
a Analysis Group, Inc. , Boston , MA , USA.
b Analysis Group, Inc. , New York , NY , USA.
Curr Med Res Opin. 2018 Apr;34(4):585-592. doi: 10.1080/03007995.2017.1411792. Epub 2017 Dec 8.
To examine real-world prescription medication usage among commercially-insured adults with attention deficit/hyperactivity disorder (ADHD) in the US.
Adults with ADHD who received ≥1 ADHD medication during 2013 were identified from a large US claims database. Combination therapy was defined as an overlap of ≥30 days between the index (first treatment ≥30 days in 2013) and another medication(s). Patients were classified into six groups: long-acting (LA) monotherapy, short-acting (SA) monotherapy, LA + LA, SA + SA, LA + SA, and >2 therapies. Analyses compared baseline characteristics by regimen, ranked combination regimens, and estimated daily average consumption (DACON) for monotherapy users.
Of 206,443 adults with ADHD (mean age = 32.9 years; 51.6% female), 56.9% used LA monotherapy, 30.7% SA monotherapy, and 12.5% used combination therapies (LA + SA: 10.3%; LA + LA: 1.3%; SA + SA: 0.4%; >2 therapies: 0.5%). Extended-release mixed amphetamine salts (MAS-XR, 39.2%) and lisdexamfetamine (LDX, 31.5%) were the most common LA monotherapies. Nearly all SA monotherapy patients received immediate-release mixed amphetamine salts (MAS-IR; 81.7%). The top three therapies among combination categories were: (a) LA + LA: branded MAS-XR + generic MAS-XR (13.7%), LDX + generic MAS-XR (10.8%), LDX + guanfacine ER (10.7%); (b) SA + SA: generic MAS-IR + clonidine IR (33.5%), generic MAS-IR + generic MPH SA (17.9%), branded MAS-IR + generic MAS-IR (11.1%); (c) LA + SA: generic MAS-XR+/-IR (39.2%), LDX + generic MAS-IR (16.7%), LA + SA generic MPH (12.6%). Among monotherapy users, DACON was 1.2 ± 0.6 (LA) and 2.1 ± 0.9 (SA) tablets.
There is significant treatment heterogeneity among US adults with ADHD. A sizable proportion of patients received monotherapies at above the recommended dosages or combination therapies, suggesting existing single-tablet regimens may not meet patients' needs.
研究美国商业保险的注意力缺陷多动障碍（ADHD）成年患者的实际处方药物使用情况。
从一个大型美国索赔数据库中识别出在2013年期间接受过≥1种ADHD药物治疗的ADHD成年患者。联合治疗定义为索引药物（2013年首次治疗≥30天）与另一种药物之间有≥30天的重叠使用期。患者被分为六组：长效（LA）单药治疗、短效（SA）单药治疗、LA+LA、SA+SA、LA+SA以及>2种治疗方法。分析比较了不同治疗方案的基线特征、对联合治疗方案进行排序，并估算了单药治疗使用者的日均消耗量（DACON）。
在206,443名ADHD成年患者中（平均年龄=32.9岁；51.6%为女性），56.9%使用LA单药治疗，30.7%使用SA单药治疗，12.5%使用联合治疗（LA+SA：10.3%；LA+LA：1.3%；SA+SA：0.4%；>2种治疗方法：0.5%）。缓释混合苯丙胺盐（MAS-XR，39.2%）和赖右苯丙胺（LDX，31.5%）是最常见的LA单药治疗药物。几乎所有SA单药治疗患者都接受速释混合苯丙胺盐（MAS-IR；81.7%）。联合治疗类别中排名前三的治疗方法为：（a）LA+LA：品牌MAS-XR+通用MAS-XR（13.7%）、LDX+通用MAS-XR（10.8%）、LDX+缓释胍法辛（10.7%）；（b）SA+SA：通用MAS-IR+可乐定IR（33.5%）、通用MAS-IR+通用MPH SA（17.9%）、品牌MAS-IR+通用MAS-IR（11.1%）；（c）LA+SA：通用MAS-XR+/-IR（39.2%）、LDX+通用MAS-IR（16.7%）、LA+SA通用MPH（12.6%）。在单药治疗使用者中，DACON为1.2±0.6（LA）片和2.1±0.9（SA）片。
美国ADHD成年患者的治疗存在显著异质性。相当一部分患者接受的单药治疗剂量高于推荐剂量或采用联合治疗，这表明现有的单片治疗方案可能无法满足患者需求。
