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Predictors of Selecting Atomoxetine Therapy for Children with Attention‐Deficit—Hyperactivity Disorder
Author(s) -
Brunt David L.,
Johnston Joseph A.,
Ye Wenyu,
Pohl Gerhardt M.,
Sun Pei J.,
Sterling Kimberly L.,
Davis Martha E.
Publication year - 2005
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.2005.25.11.1541
Subject(s) - atomoxetine , attention deficit hyperactivity disorder , atomoxetine hydrochloride , psychology , psychiatry , medicine , clinical psychology , methylphenidate
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.