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

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.

Keywords:

• Attention deficit/hyperactivity disorder
• claims analysis
• combination therapy
• long-acting
• short-acting
• stimulant

Transparency

Declaration of funding

This work was funded by Shire Human Genetic Therapeutics, Inc. The sponsor was involved in all stages of the study research and manuscript preparation.

Declaration of financial/other relationships

RG and VS were employees of Shire at the time the study was performed and own Shire stock/stock options. ZZ, Z-YZ, SSK, and JX are employees of Analysis Group, Inc., which has received consultancy fees from Shire. A reviewer on this manuscript has acted as a speaker and board member for Shire France & Shire Europe in the last 5 years. Another reviewer on this manuscript declares consultancy for Shire, Medicis Pharmaceutical, and Pfizer, and research support from Shire, Pfizer, and Supernus. Peer reviewers on this manuscript have received an honorarium from CMRO for their review work.

Acknowledgments

Medical writing assistance was provided by Shelley Batts, PhD, an employee of Analysis Group, Inc.

Notes

1 Trademark of Shire Pharmaceuticals.

2 Trademark of Medeva Pharmaceuticals.

3 Trademark of Mallinckrodt, Inc.

4 Trademark of Novartis Pharmaceuticals.

5 Trademark of NextWave Pharmaceuticals.

6 Trademark of ALZA Corp.

7 Trademark of Amedra Pharmaceuticals.

8 Trademark of Shire LLC.

9 Trademark of Shire LLC.

10 Trademark of Eli Lilly and Company.

11 Trademark of Concordia Pharmaceuticals.

12 Trademark of Shire LLC.

13 Trademark of Teva Pharmaceuticals.