Open AccessClinical Impact of Not Achieving Recommended Dose on Duration of Atomoxetine Treatment in Adults with Attention‐Deficit/Hyperactivity Disorder
Author(s) -
Clemow David B.,
Nyhuis Allen W.,
Robinson Rebecca L.
Publication year - 2016
Publication title -
cns neuroscience and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 69
eISSN - 1755-5949
pISSN - 1755-5930
DOI - 10.1111/cns.12595
Subject(s) - atomoxetine , medicine , medical prescription , atomoxetine hydrochloride , retrospective cohort study , attention deficit hyperactivity disorder , cohort , combination therapy , pharmacology , psychiatry , methylphenidate
Summary Aim To compare atomoxetine ( ATX ) length of therapy (LoT) among adults with ADHD who reached the recommended dose of 80 mg/day ( ATX ≥ 80) versus those who did not ( ATX < 80) analyzed separately in patients prescribed ATX as monotherapy (mono) and in combination with other ADHD medications (combo). Methods This was a retrospective observational cohort study of the Truven Health Marketscan Commercial Claims Database from January 1, 2006–September 30, 2013, with a 6‐month preindex period free of ATX (1st ATX claim as index event) and a 1‐year follow‐up. LoT during follow‐up was calculated using prescription claim fill dates and included all days with medication on hand regardless of treatment gaps. Results Only 45.0% of the 36,076 mono and 77.9% of the 1548 combo patients reached an ATX dose of ≥80 mg/day in 1‐year follow‐up. When patients filled at least one 80 mg prescription, their total days of therapy over the course of a year were significantly greater than if they did not (mono: 159.3 vs. 65.6 days; combo: 237.4 vs. 172.0; P < 0.0001). Across all timepoints examined (Day 14, 30, 60, 90, 210) for mono and combo, ATX ≥ 80 versus ATX < 80 patients had greater mean doses ( P < 0.0001). Combo patients had longer ATX LoT than mono patients regardless if they reached 80 mg or not ( P < 0.0001), but mono patients LoT was 93.8 days longer for ATX ≥ 80 versus ATX < 80 patients compared to 65.5 days for combo patients. Of patients reaching 80 mg/day, 71.7% of mono and 62.8% of combo patients did so by Day 30. For mono ATX ≥ 80 and ATX < 80 patients, LoT was significantly ( P < 0.0001) less in previously treated patients compared to naive patients. Conclusion Ensuring adult ADHD patients are treated with ATX at a target dose of 80 mg/day is an important clinical consideration for maximizing patient days on therapy, which can be important for treatment optimization.