Persistence of pharmacological treatment into adulthood, in UK primary care, for ADHD patients who started treatment in childhood or adolescence

BMC Psychiatry

Ian CK Wong¹  Philip Asherson²  Paul Hodgkins⁴  Macey L Murray³  Lynda Wilton³  Suzanne McCarthy⁵ 

[1]Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong

[2]MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London, UK

[3]Centre for Paediatric Pharmacy Research, UCL School of Pharmacy, London, UK

[4]Shire Pharmaceuticals LLC, Wayne, PA, USA

[5]Pharmacy Department, Cork University Hospital, Cork, Ireland

关键词: Adulthood;    Persistence;    Stimulants;    Pharmacological treatment;    Attention deficit hyperactivity disorder;   

Others  :  1124213
DOI  :  10.1186/1471-244X-12-219

 received in 2012-03-26, accepted in 2012-11-20,  发布年份 2012

【 摘 要 】

Background

ADHD guidelines in the UK suggest that children and adults who respond to pharmacological treatment should continue for as long as remains clinically effective, subject to regular review. To what extent patients persist with treatment from childhood and adolescence into adulthood is not clear. This study aims to describe, in UK primary care, the persistence of pharmacological treatment for patients with ADHD who started treatment aged 6–17 years and to estimate the percentage of patients who continued treatment from childhood and adolescence into adulthood.

Methods

The Health Improvement Network (THIN) database was used to identify patients with ADHD who received their first prescription for methylphenidate/ dexamfetamine/atomoxetine, aged 6–17 years. Patients were monitored until their ‘censored date’ (the earliest of the following dates: date the last prescription coded in the database ended, end of the study period (31st December 2008), date at which they transferred out of their practice, date of death, the last date the practice contributed data to the database). Persistence of treatment into adulthood was estimated using Kaplan Meier analysis.

Results

610 patients had follow-up data into adulthood. 213 patients (93.4% male) started treatment between 6–12 years; median treatment duration 5.9 years. 131 (61.5%) stopped before 18 years, 82 (38.5%) were still on treatment age ≥18 years. 397 patients (86.4% male) started treatment between 13–17 years; median treatment duration was 1.6 years. 227 (57.2%) stopped before 18 years, 170 (42.8%) were still on treatment age ≥18 years. The number of females in both age categories was too small to formally test for differences between genders in persistence of treatment.

Conclusion

Persistence of treatment into adulthood is lower (~40%) compared with published rates of persistence of the condition (~65% when symptomatic definition of remission used). Due to the limited number of patients with data past 18 years, it is important that ongoing monitoring of prescribing into later adulthood is undertaken, particularly to observe the effects of recommendations in new guidelines.

【 授权许可】

   
2012 McCarthy et al.; licensee BioMed Central Ltd

【 图 表 】

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