美国商业保险人群中患有注意力缺陷多动障碍的成年人的药物使用情况。

Medication use in adults with attention deficit/hyperactivity disorder in a commercially-insured population in the United States.

作者信息

Zhou Zhou, Zhou Zheng-Yi, Kelkar Sneha S, Sikirica Vanja, Xie Jipan, Grebla Regina

机构信息

a Analysis Group, Inc. , Boston , MA , USA.

b Analysis Group, Inc. , New York , NY , USA.

出版信息

Curr Med Res Opin. 2018 Apr;34(4):585-592. doi: 10.1080/03007995.2017.1411792. Epub 2017 Dec 8.

DOI:10.1080/03007995.2017.1411792

PMID:29186993

Abstract

OBJECTIVE

To examine real-world prescription medication usage among commercially-insured adults with attention deficit/hyperactivity disorder (ADHD) in the US.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

摘要

目的

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。

方法

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）。

结果

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。