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Continuity of Methylphenidate Treatment for Attention-Deficit/Hyperactivity Disorder
Open accessAbstract
OBJECTIVE: To compare the continuity of methylphenidate hydrochloride (MPH) therapy among youth Medicaid beneficiaries treated for attention-deficit/hyperactivity disorder with immediate-release (IR) or extended-release (ER) MPH formulations. Method An analysis was conducted of statewide California Medicaid claims (2000-2003) focusing on children and adolescents, ages 6 to 17 years, who started ER-MPH or IR-MPH treatment for attention-deficit/hyperactivity disorder. The study cohorts were limited to youth who had not filled a prescription for MPHs, amphetamines, pemoline, or atomoxetine for 6 months preceding the index prescription and remained eligible for Medicaid benefits for the following 12 months. The study groups were compared with respect to background demographic traits and clinical characteristics. Mean and median duration of MPH treatment episodes were defined to terminate if a gap of 30 or more days occurred from the end of the last prescription supply to the start of the next prescription. Survival time ratios were used to assess treatment duration controlling for group differences in background characteristics. RESULTS: As compared with patients initiating IR-MPH treatment, patients initiating ER-MPH treatment had a significantly longer mean estimated duration of treatment (ER-MPH, 140.3 days [95% confidence interval (CI), 136.3-144.4 days] vs IR-MPH, 103.4 days [95% CI, 101.3-103.4 days]). Similar results were found in analyses stratified by patient age, race/ethnicity, and sex. Controlling for group differences in age, sex, race/ethnicity, coprescribed psychotropic medications, other treated mental disorders, case management, managed care participation, and seasonal effects, ER-MPH treatment initiation was associated with an average 37% longer duration of treatment than IR-MPH treatment (survival time ratio, 1.37 [95% CI, 1.32-1.42]). Among patients treated with ER-MPH, treatment initiation with an osmotic release oral system MPH (Concerta) was associated with significantly longer mean duration (147.2 days [95% CI, 142.6-151.7 days]) than treatment initiation with Metadate CD (controlled delivery) (113.0 days [95% CI, 100.9-125.1 days]) or Ritalin LA (long acting) (101.1 days [95% CI, 91.2-111.0 days]), respectively. CONCLUSIONS: Extended-release MPH formulations were associated with greater continuity of MPH treatment than IR formulations in the study population. Initial selection of an ER formulation may help to prolong continuity of MPH therapy among youth Medicaid beneficiaries with attention-deficit/hyperactivity disorder.
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“Nonadherence has been linked to a variety of factors, ranging from proximal and practical aspects of medication administration and/or immediately recognized side effects to more distal factors, including family socioeconomic status and ethnicity.3,22,23”
From Medication Adherence in the MTA: Saliva Methylphenidate Samples Versus Parent Report and Mediating Effect of Concomitant Behavioral Treatment (2009) · cites this paper as [23]
In the citing paper
“The current literature on ethnic disparities in adherence is somewhat inconsistent: some studies indicate that minority youths are at increased risk for premature treatment discontinuation and lower use of psychiatric services and medication, 23,31 but other studies suggest no ethnic disparities in mental health prescription rates, referrals, and counseling once a diagnosis is made.32,33”
From Medication Adherence in the MTA: Saliva Methylphenidate Samples Versus Parent Report and Mediating Effect of Concomitant Behavioral Treatment (2009) · cites this paper as [23]
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3-year follow-up of the NIMH MTA study
JENSEN, P. S., ARNOLD, L. E., SWANSON, J. M., VITIELLO, B., ABIKOFF, H. B., GREENHILL, L. L., HECHTMAN, L., HINSHAW, S. P., PELHAM, W. E., WELLS, K. C., et al. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3180686d48 · Cited by 643
Review of Medication Adherence in Children and Adults with ADHD
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Metadata
- Authors
- Marcus, S. C., Wan, G. J., Kemner, J. E., & Olfson, M.
- Affiliations
- University of Pennsylvania (US)
- Venue
- Archives of Pediatrics & Adolescent Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2005-06-01
- Volume
- 159
- Issue
- 6
- Pages
- 572
- ISSN
- 1072-4710 (ISSN-L)
- OpenAlex
- W2046837347
- Cited by
- 163
- References
- 42
- Citations by year
- 2026: 2 · 2024: 1 · 2023: 5 · 2022: 3 · 2021: 9 · 2020: 2 · 2019: 4 · 2018: 5 · 2017: 9 · 2016: 6 · 2015: 10 · 2014: 13 · 2013: 12 · 2012: 14
- FWCI
- 6.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Keywords
- methylphenidate, attention deficit hyperactivity disorder, sustained-release formulation, immediate-release formulation, treatment continuity, treatment duration, Medicaid beneficiaries, youth, osmotic-release oral system, Concerta, medication adherence, psychotropic drug use, managed care, case management, survival analysis, racial and ethnic disparities
- MeSH terms
- Adolescent, Age Factors, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, California, Child, Delayed-Action Preparations, Female, Humans, Male, Medicaid, Medicine, Methylphenidate, Patient Compliance, Psychotropic Drugs, Specialization, Multivariate Analysis, Case Management, Racial Groups
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