Predictors of selecting atomoxetine therapy for children with attention-deficit-hyperactivity disorder.

Abstract

STUDY OBJECTIVE:

To investigate predictors of beginning treatment with atomoxetine, a new attention-deficit-hyperactivity disorder (ADHD) drug, shortly after it was introduced into the marketplace compared with well-established stimulants for children in a managed care setting.

DESIGN:

Retrospective cohort analysis.

DATA SOURCE:

Managed care claims database.

PATIENTS:

A total of 45,144 patients aged 18 years or younger who filled a prescription for an ADHD-specific drug.

MEASUREMENTS AND MAIN RESULTS:

For each patient, the most recent start of therapy between April 1 and December 31, 2003, was categorized by drug: atomoxetine; any stimulant; or short-, intermediate-, or long-acting stimulant. The categories were based on the first use of the drug without use of a drug in that same category in the previous 3 months. Logistic regression analysis of past-year administrative claims was applied to determine predictors of the start of specific pharmacotherapy. Patients with a claim of ADHD with hyperactivity were 1.50 times more likely to begin therapy with atomoxetine than with any stimulant (95% confidence interval [CI] 1.42-1.58). Patients with a history of tics (odds ratio [OR] 3.11, 95% CI 2.54-3.82), anxiety (OR 1.35, 95% CI 1.24-1.48), pervasive developmental disorders (OR 2.00, 95% CI 1.69-2.37), or frequent use of behavioral care services (OR 1.34, 95% CI 1.21-1.48) were predisposed to starting treatment with atomoxetine relative to any stimulant, but patients with obesity were not (OR 0.68, 95% CI 0.53-0.87). A short-acting stimulant was specifically preferred for patients with narcolepsy or hypersomnolence (OR 0.33, 95% CI 0.20-0.56). Alcohol dependence, but not drug dependence or drug abuse, was predictive of the selection of atomoxetine over a short-acting stimulant (OR 2.98, 95% CI 1.25-7.09).

CONCLUSION:

Atomoxetine therapy was systematically preferred for patients with psychiatric comorbidities, contraindications to stimulants, or relatively heavy use of behavioral health care.

• Authors: David L Van Brunt, Joseph A Johnston, Wenyu Ye, Gerhardt M Pohl, Pei J Sun, Kimberly L Sterling, Martha E Davis
• Journal: Pharmacotherapy (Pharmacotherapy) Vol. 25 Issue 11 Pg. 1541-9 (Nov 2005) ISSN: 0277-0008 [Print] United States
• PMID: 16232017 (Publication Type: Journal Article)

Chemical References

• Propylamines
• Atomoxetine Hydrochloride

Topics

• Adolescent
• Atomoxetine Hydrochloride
• Attention Deficit Disorder with Hyperactivity (drug therapy, psychology)
• Child
• Child Behavior (drug effects)
• Child, Preschool
• Cohort Studies
• Female
• Humans
• Infant
• Infant, Newborn
• Male
• Managed Care Programs
• Propylamines (therapeutic use)
• Retrospective Studies