Prevalence, incidence and persistence of ADHD drug use in Japan

Okumura, Yasuyuki; Usami, Masahide; Okada, Takashi; Saito, Takuya; Negoro, Hiromitsu; Tsujii, Noa; Fujita, Junichi; Iida, Junzo

doi:10.1017/s2045796018000252

Cited by 13 publications

(9 citation statements)

References 14 publications

(30 reference statements)

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“…OROS methylphenidate was the most frequently prescribed medication in this study. This result was consistent with a retrospective cohort study using the National Database of Health Insurance Claim Information, in which the percentage of methylphenidate use among ADHD medication users was 64% in Japan [ 19 ]. Considering that methylphenidate is the most frequently used medication in children with ADHD in the UK (94%; [ 20 ]), Norway (94%; [ 21 ]), and Germany (75%–100%; [ 22 ]), the finding of 73.1% in this study is not high.…”

Section: Discussionsupporting

confidence: 90%

Current use of attention-deficit hyperactivity disorder (ADHD) medications and clinical characteristics of child and adolescent psychiatric outpatients prescribed multiple ADHD medications in Japan

et al. 2021

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Background/aim Patients with attention-deficit hyperactivity disorder (ADHD) manifest symptoms of hyperactivity, impulsivity, and/or inattention. ADHD medications available in Japan are limited compared with those in Western countries. Prescribing status has not been sufficiently evaluated in clinical settings in Japan. This study investigated the current use of ADHD medications and characteristics of patients who received multiple ADHD medications in a clinical setting in Japan. Methods Study participants were those who visited the Department of Child and Adolescent Psychiatry, Kohnodai Hospital between April 2015 and March 2020. We investigated patients who received osmotic-controlled release oral delivery system methylphenidate, atomoxetine, or guanfacine. A retrospective case–control design was used to evaluate the characteristics of patients who received multiple ADHD medications. Patients who were given three ADHD medications were defined as the case group. Randomly sampled sex- and age-matched patients diagnosed with ADHD were defined as the control group. We compared data for child-to-parent violence, antisocial behavior, suicide attempt or self-harm, abuse history, refusal to attend school, and two psychological rating scales (the ADHD-Rating Scale and Tokyo Autistic Behavior Scale). Results Among the 878 patients who were prescribed any ADHD medications, 43 (4.9%) received three ADHD medications. Logistic regression revealed that children with severe ADHD symptoms, autistic characteristics, or tendency of child-to-parent violence were more likely to have been prescribed three medications during their treatment. Conclusions Our findings suggest the approach to prevent the use of multiple ADHD medications. A prospective study to investigate the causality between prescribing status and clinical characteristics is warranted.

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Section: Discussionsupporting

confidence: 90%

Current use of attention-deficit hyperactivity disorder (ADHD) medications and clinical characteristics of child and adolescent psychiatric outpatients prescribed multiple ADHD medications in Japan

et al. 2021

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“…A recent study assessing usage of ADHD drugs in Japan reported that among child and adolescent prevalent users of ADHD medications, approximately 64% were prescribed MPH and 41% were prescribed atomoxetine during 2014 19 . These proportions are different from those reported here, likely because guanfacine was approved in Japan after the study by Okumura et al was done, and because the present study included adult patients.…”

Section: Discussioncontrasting

confidence: 70%

Medications for attention‐deficit/hyperactivity disorder in Japan: A retrospective cohort study of label compliance

Fife

Voss

Hardin

et al. 2021

Neuropsychopharm Rep

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Aim To assess label compliance in prescription of medications approved for treatment of attention‐deficit/hyperactivity disorder (ADHD) in Japan at the time of this study: methylphenidate (MPH), atomoxetine, and guanfacine. Methods Retrospective descriptive study was conducted in prevalent‐user cohorts from the Japan Medical Data Center database. Patients who were prescribed a study drug between January 1, 2013 and September 30, 2018 and were in the database for ≥30 days were included. A prescription was considered compliant if all 4 criteria were satisfied: appropriate age, daily dose not exceeding the approved maximum, no contraindicated concurrent medications, and no contraindicated conditions. Results Among 17 418 patients who were prescribed a study drug during 2013‐2018, 73% were male and 53% were children (aged <18 years). Fewer than 2% of prescriptions were for patients outside the approved age, 10%‐13% of patients in the atomoxetine and MPH cohorts received ≥1 prescription exceeding maximum approved dose, no patients were co‐prescribed a contraindicated medication, and 16%–18% of patients in the MPH cohorts had ≥1 contraindicated condition. During their first 500 days of use, for approximately 73%‐86% of patients, all prescriptions were compliant with all label requirements. Conclusions Among patients exposed to ADHD medications in Japan during 2013‐2018, nearly all prescriptions for these medications were label‐compliant for age. For >85% of patients, all prescriptions were label‐compliant for dose, and for approximately 80%, all prescriptions were label‐compliant for contraindicated conditions. We did not find evidence of widespread abuse or noncompliant use of prescribed ADHD medications.

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“…The trend for a gradual increase in prescription rates is similar to that of other countries 26 – 29 . However, the prevalence of ADHD drug use in pediatric patients was lower in Japan (0.4%) 30 than in Norway and the United States (1.4–5.3%) 31 , 32 but similar to that in Italy, France, and the UK (0.2–0.5%) 33 – 35 . In addition, the share of OROS-MPH in 2014 is lower in Japan (64%) 30 than in Germany, the UK, and Norway (75–100%) 32 , 33 , 36 .…”

Section: Discussionmentioning

confidence: 76%

Risk factors for low adherence to methylphenidate treatment in pediatric patients with attention-deficit/hyperactivity disorder

Ishizuya

Enomoto

Tachimori

et al. 2021

Sci Rep

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Poor adherence is a major concern in the treatment of attention-deficit/hyperactivity disorder (ADHD). The objective of this study was to evaluate factors linked to early interruption of and low adherence to treatment with osmotic-release oral system methylphenidate hydrochloride (OROS-MPH) in pediatric patients with ADHD. A total of 1353 young people (age 6–17 years) with a diagnosis of ADHD who newly started OROS-MPH were extracted from the pharmacoepidemiological data of 3 million people in Japan. The cohort was retrospectively surveyed every month for 12 months. Ten possible risk factors were extracted from the data and analyzed by multivariable logistic regression. Sensitivity analysis was conducted to ensure the robustness of the analysis. The results revealed that treatment adherence was generally poor, with a tendency for discontinuation in the early stage. Multivariable logistic regression results showed that adherence is reduced by female sex, lower starting dose, and concomitant atomoxetine or hypnotics. These findings may help clinicians to predict the risk of poor adherence in the early stage of treatment and improve not only patients’ symptoms, but also their quality of life.

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Prevalence, incidence and persistence of ADHD drug use in Japan

Abstract: Utilization of stimulants and atomoxetine for attention-deficit/hyperactivity disorder among 5.4 million children using population-based longitudinal data. Basic & Clinical Pharmacology &

Cited by 13 publications

References 14 publications

Current use of attention-deficit hyperactivity disorder (ADHD) medications and clinical characteristics of child and adolescent psychiatric outpatients prescribed multiple ADHD medications in Japan

Current use of attention-deficit hyperactivity disorder (ADHD) medications and clinical characteristics of child and adolescent psychiatric outpatients prescribed multiple ADHD medications in Japan

Medications for attention‐deficit/hyperactivity disorder in Japan: A retrospective cohort study of label compliance

Risk factors for low adherence to methylphenidate treatment in pediatric patients with attention-deficit/hyperactivity disorder

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