Takeda Pharmaceuticals USA, 95 Hayden Ave, Lexington, MA, 02421, USA.
Analysis Group, Boston, MA, USA.
CNS Drugs. 2021 May;35(5):575-589. doi: 10.1007/s40263-021-00808-x. Epub 2021 Apr 15.
Attention-deficit/hyperactivity disorder (ADHD) treatment rates in adults are low, possibly owing to discontinuation of pediatric care due to various circumstances (including inadequate health insurance coverage, poor disease insight, and patient/family resistance, as well as those who manage their ADHD independent of pharmacologic intervention) during the transition from adolescence to adulthood. To improve the understanding of treatment patterns during this transition, this study characterized pharmacotherapy use in patients with ADHD aged 16-21 years.
A retrospective claims analysis of the IBM MarketScan Commercial Databases, which represent all census regions of the USA, included patients aged 16-21 years with two or more ADHD diagnoses between 1/1/2008 and 12/31/2017 (one or more diagnoses during the year of age 17) who were continuously enrolled from ages 16-21 years and prescribed ADHD medication for ≥ 6 months at age 17 years. Pharmacotherapy use was assessed longitudinally. Comparisons between ages were conducted using Wilcoxon signed-rank tests and McNemar tests. Treatment discontinuation was estimated using Kaplan-Meier analyses.
The analysis included 10,292 patients. The overall percentage of patients receiving pharmacotherapy significantly decreased (p < 0.001, regardless of treatment type and presence of co-occurring psychiatric disorders) as patients aged, with a median time to treatment discontinuation of 2.94 years. Among patients using pharmacotherapy at the age of 17 years, more than 30% were no longer using pharmacotherapy at age 21 years. As patients aged, the percentage using long-acting amphetamines or methylphenidates decreased, and the percentage receiving no treatment increased. The percentage of patients with disrupted treatment from age 18 to 21 years ranged from 17.9 to 24.1%. After transitioning to disrupted treatment or no treatment, low percentages of patients returned to pharmacotherapy use (disrupted treatment: 15.7-21.5% per year; no treatment, 2.7-3.8% per year). Across all age groups, statistically significantly greater (p < 0.05) percentages of patients with co-occurring psychiatric disorders used lisdexamfetamine, dextroamphetamine-amphetamine mix short acting, and non-stimulants compared with patients without co-occurring psychiatric disorders. Patients with co-occurring psychiatric disorders remained on ADHD pharmacotherapy longer and switched or augmented their pharmacotherapy more frequently than patients without co-occurring psychiatric comorbidities.
Patients rarely reinitiated treatment after pharmacotherapy was disrupted or discontinued, emphasizing the need for increased focus on the management of ADHD as patients transition from adolescence to adulthood.
由于各种原因（包括保险覆盖不足、疾病认知度低、患者/家庭抵制以及那些独立于药物干预管理 ADHD 的人），在青少年向成年过渡期间，小儿保健服务中断，导致注意力缺陷/多动障碍（ADHD）的成人治疗率较低。为了更好地了解这一过渡期间的治疗模式，本研究对年龄在 16-21 岁的 ADHD 患者的药物治疗使用情况进行了特征描述。
本研究对代表美国所有普查区域的 IBM MarketScan 商业数据库进行了回顾性索赔分析，纳入了 2008 年 1 月 1 日至 2017 年 12 月 31 日期间有两次或以上 ADHD 诊断的年龄在 16-21 岁之间的患者（在 17 岁时有一次或以上诊断），这些患者在 16-21 岁期间持续参保，且在 17 岁时至少使用 ADHD 药物治疗 6 个月。采用纵向评估药物治疗的使用情况。使用 Wilcoxon 符号秩检验和 McNemar 检验对不同年龄组进行比较。采用 Kaplan-Meier 分析估计治疗中断情况。
本分析共纳入了 10292 名患者。随着患者年龄的增长，接受药物治疗的患者比例总体显著下降（p < 0.001，无论治疗类型和是否合并精神疾病），治疗中断的中位时间为 2.94 年。在 17 岁时使用药物治疗的患者中，超过 30%的患者在 21 岁时不再使用药物治疗。随着患者年龄的增长，使用长效安非他命或哌醋甲酯的比例下降，而不接受治疗的比例增加。从 18 岁到 21 岁之间，中断治疗的患者比例在 17.9%至 24.1%之间。从接受治疗转为中断治疗或不治疗后，仅有较低比例的患者重新开始药物治疗（中断治疗：每年 15.7%-21.5%；不治疗：每年 2.7%-3.8%）。在所有年龄组中，与无共患精神疾病的患者相比，合并共患精神疾病的患者使用拉莫三嗪、右旋苯丙胺-苯丙胺混合物短效和非兴奋剂的比例显著更高（p < 0.05）。合并共患精神疾病的患者接受 ADHD 药物治疗的时间更长，更频繁地转换或增强药物治疗。
药物治疗中断或停止后，患者很少重新开始治疗，这强调了随着患者从青少年过渡到成年，需要更加关注 ADHD 的管理。
