gms | German Medical Science

MAINZ//2011: 56. GMDS-Jahrestagung und 6. DGEpi-Jahrestagung

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V.
Deutsche Gesellschaft für Epidemiologie e. V.

26. - 29.09.2011 in Mainz

Methylphenidate and atomoxetine treatment of ADHD in children and youths in Germany

Meeting Abstract

  • Ingo Langner - Bremen Institute for Prevention Research and Social Medicine (BIPS), Bremen
  • Kathrin Jobski - Bremen Institute for Prevention Research and Social Medicine (BIPS), Bremen
  • Rafael T. Mikolajczyk - Bremen Institute for Prevention Research and Social Medicine (BIPS), Bremen
  • Angela A. Kraut - Bremen Institute for Prevention Research and Social Medicine (BIPS), Bremen
  • Edeltraut Garbe - Bremen Institute for Prevention Research and Social Medicine (BIPS), Bremen

Mainz//2011. 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi). Mainz, 26.-29.09.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11gmds235

DOI: 10.3205/11gmds235, URN: urn:nbn:de:0183-11gmds2351

Published: September 20, 2011

© 2011 Langner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Background: Total prescriptions of methylphenidate have multiplied by a factor of 184 from 1990 to 2009 in Germany, but little is known about drug treatment of ADHD on individual patient level.

Objectives: To describe drug treatment of ADHD in children and youths in Germany.

Methods: Using data from one large German health insurance (>7.2 million insurees), a cohort of children aged 3-17 years with a first diagnosis of ADHD in 2005 was followed until discontinuation of insurance, death, or December 31st, 2008 whichever was earliest. Kaplan-Meier estimates for onset of drug treatment with methylphenidate (MPH) or atomoxetine (ATX) were calculated for different follow-up time stratified by sex. First drug treatment, galenic formulation of first MPH treatment, and switches between ATX and MPH were ascertained. Psychiatric comorbidities, age, sex and ADHD-subtype were investigated as predictors of early (<6 months after cohort entry) vs. late or no drug treatment using logistic regression.

Results: 6,210 newly diagnosed ADHD patients (1,443 girls) with a total follow-up time of 20,817 person- years (girls: 4,827 person-years) were identified. The proportion of boys (girls) with a first prescription of MPH or ATX within 90, 183, 365 days or 3 years was 29.6 (27.9), 36.6 (34.5), 43.0 (39.0) and 52.8 (46.9) percent, respectively. Among those who received treatment, 91.6% were started on MPH and 8.4% on ATX. While 17.7% of MPH treated patients were started on a retard formulation, this proportion increased to 59.6% within the first year. During the first year of follow-up after initiation of treatment, 31.9% of patients started on ATX received at least one MPH prescription, whereas in 5.8% of patients started on MPH, a switch of drug treatment to ATX was observed. Significant predictors of early drug treatment were behavioural and emotional disorders (F91-F99, OR=1.29, 95%CI 1.11-1.50) and a diagnosis of ADHD with conduct disorder (OR=1.26, 95%CI 1.11-1.44).

Conclusions: About one third of ADHD children and youth with new diagnoses of ADHD received drug treatment in the first three months and about half within three years. A considerable number of patients received MPH retard formulations already at treatment initiation.