Drug survival and risk factors for ADHD medication discontinuation in adults: A Danish Nationwide Registry-based cohort study

IF 5.3 2区医学 Q1 PSYCHIATRY Acta Psychiatrica Scandinavica Pub Date : 2024-07-03 DOI:10.1111/acps.13724

Pelle Lau Ishøy, Kim Berg Engersgaard Johannessen, Tine Houmann, Eline Levin, Per Hove Thomsen

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Abstract

Introduction

Attention deficit hyperactivity disorder (ADHD) medication has proven effective for treating ADHD in adults, nonetheless previous studies have shown high rates of medication discontinuation.

Objective

To assess drug survival and identify risk factors associated with discontinuation of ADHD medication.

Methods

A nationwide registry-based cohort study in Danish adults who redeemed a prescription for ADHD medication for the first time between 2010 and 2015. All patients were followed for 5 years from the first redeemed prescription. Discontinuation was defined as a gap of 12 months between redemptions. Logistic regression analysis with odds ratio (OR) and Kaplan Meier analysis were used to examine risk factors (sex, age, socioeconomic status, substance use disorders, and comorbidities) associated with discontinuation.

Results

Twenty three thousand nine-hundred and sixteen patients with ADHD were identified. The 5-year overall drug survival was 29% in women vs. 23.5% in men. The risk of medication discontinuation was significantly higher in men compared to women, OR 1.26 (95% CI 1.19–1.34, p < 0.001). Adults aged 31–50 years had a significantly decreased risk of medication discontinuation compared to adults aged 18–30 years, OR 0.57 (95% CI 0.53–0.61, p < 0.001). Switching ADHD medication two times or three times or more significantly decreased the risk of discontinuation; OR 0.53 (95% CI 0.49–0.56, p < 0.001) and OR 0.26 (95% CI 0.23–0.30, p < 0.001), respectively. Substance use disorders and certain comorbidities were associated with medication discontinuation. Eating disorders, OR 0.71 (95% CI 0.64–0.78, p < 0.001), intellectual disabilities, OR 0.65 (95% CI 0.59–0.73, p < 0.001) and sleep disorders, OR 0.42 (95% CI 0.37–0.49, p < 0.001) were associated with continuation of ADHD medication.

Conclusions

The 5-year overall drug survival was longer in women compared to men. Women with ADHD; adults aged 31–50; and patients with comorbid eating disorder; intellectual disability; sleep disorder and medication switching were individually associated with continuation of ADHD medication. Various factors were associated with medication discontinuation. Discontinuation should be acknowledged as a common phenomenon in patients with ADHD and calls for increased attention from the treatment responsible prescriber or team. Moreover, our findings suggest that timely, frequent medication switching, or temporary regimens may indeed represent optimal management strategies for a significant proportion of the ADHD population.

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成人多动症的药物存活率和停药风险因素：一项基于丹麦全国登记处的队列研究。

简介：事实证明，注意力缺陷多动障碍（ADHD）药物能有效治疗成人ADHD，但以往的研究表明，药物的停用率很高：评估药物存活率，并确定与停用 ADHD 药物相关的风险因素：方法：对 2010 年至 2015 年间首次兑换 ADHD 药物处方的丹麦成人进行全国性登记队列研究。自首次兑换处方起，对所有患者进行为期 5 年的随访。停药定义为两次换药之间间隔 12 个月。我们采用几率比（OR）逻辑回归分析和卡普兰-梅耶尔分析来研究与停药相关的风险因素（性别、年龄、社会经济地位、药物使用障碍和合并症）：共发现 23916 名多动症患者。女性的 5 年总体药物存活率为 29%，而男性为 23.5%。与女性相比，男性的停药风险明显更高，OR 值为 1.26（95% CI 为 1.19-1.34，p 结论：男性的停药风险明显高于女性，OR 值为 1.26（95% CI 为 1.19-1.34，p）：与男性相比，女性的 5 年总体药物存活期更长。患有多动症的女性、31-50 岁的成年人、合并饮食失调、智力障碍、睡眠障碍和换药的患者与继续服用多动症药物存在个体相关性。多种因素与停药有关。应该承认，停药是多动症患者的常见现象，需要负责治疗的处方医生或团队给予更多关注。此外，我们的研究结果表明，及时、频繁换药或临时用药方案可能确实是相当一部分多动症患者的最佳治疗策略。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.