Background and Objective

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.

Methods

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.

Results

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.

Conclusions

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.

中文翻译：

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注意力缺陷/多动障碍患者从青春期到成年早期的药物治疗中断：美国索赔数据库分析

背景与目的

成人注意力缺陷/多动障碍 (ADHD) 治疗率较低，可能是由于各种情况（包括健康保险覆盖范围不足、疾病洞察力差、患者/家庭抵抗力以及管理他们的 ADHD 独立于药物干预）在从青春期到成年期的过渡期间。为了提高对这一过渡期间治疗模式的理解，本研究对 16-21 岁 ADHD 患者的药物治疗进行了描述。

方法

对代表美国所有人口普查区域的 IBM ^® MarketScan ^®商业数据库进行的一项回顾性索赔分析包括 2008 年 1 月 1 日至 2017 年 12 月 31 日期间患有两次或两次以上 ADHD 诊断的 16-21 岁患者（一个或在 17 岁期间有更多诊断）从 16 岁到 21 岁连续入组，并在 17 岁时服用 ADHD 药物 ≥ 6 个月。纵向评估药物治疗的使用。使用 Wilcoxon 符号秩检验和 McNemar 检验进行年龄之间的比较。使用 Kaplan-Meier 分析估计治疗中断。

结果

该分析包括 10,292 名患者。接受药物治疗的患者总体百分比显着下降（p< 0.001，无论治疗类型和是否存在同时发生的精神疾病）随着患者年龄的增长，中位治疗中断时间为 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，使用长效苯丙胺或哌醋甲酯的百分比下降，而未接受治疗的百分比增加。从 18 岁到 21 岁中断治疗的患者比例在 17.9% 到 24.1% 之间。在过渡到中断治疗或不治疗后，低百分比的患者恢复使用药物治疗（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，统计学上显着更高（p< 0.05) 与没有同时发生精神疾病的患者相比，使用 lisdexamfetamine、右旋苯丙胺-苯丙胺混合短效药物和非兴奋剂的合并精神疾病患者的百分比。与没有同时发生精神疾病的患者相比，同时发生精神疾病的患者接受 ADHD 药物治疗的时间更长，并且更频繁地转换或加强他们的药物治疗。

结论

药物治疗中断或停止后患者很少重新开始治疗，强调随着患者从青春期过渡到成年期，需要更加关注 ADHD 的管理。