Patterns of attention deficit hyperactivity disorder medicine use in the era of new non-stimulant medicines: A population-based study among Australian children and adults (2013–2020)

Abstract

Background and aims: New therapeutic options such as lisdexamfetamine and guanfacine have recently become available for the treatment of attention deficit hyperactivity disorder. We described contemporary patterns of attention deficit hyperactivity disorder medicine use among children, adolescents and adults in Australia. Methods: This population-based study used dispensing data for a 10% random sample of Australian residents between July 2012 and December 2020. We estimated the annual prevalence and incidence of attention deficit hyperactivity disorder medicines, second-line guanfacine use and examined concurrent medicine use of both stimulants and non-stimulants. We followed incident users for up to 5 years and analysed treatment persistence using a novel proportion of people covered method. Analyses were stratified by attention deficit hyperactivity disorder medicine, sex and age group; young children (0–5 years), children (6–12 years), adolescents (13–17 years), young adults (18–24 years) and adults (⩾25 years). Results: We observed a twofold increase in the overall prevalence of attention deficit hyperactivity disorder medicine use between 2013 and 2020, from 4.9 to 9.7 per 1000 persons. Incident use also increased across all age groups and both sexes, with the most pronounced increases among adolescent females (from 1.4 to 5.3 per 1000 persons). Stimulant treatment persistence after 5 years was highest among those initiating treatment as young children (64%) and children (69%) and lowest among those initiating treatment in adolescence (19%). Concurrent use of stimulants and non-stimulants was more common among males and younger age groups. Most children (87%) initiating guanfacine had prior dispensings of attention deficit hyperactivity disorder medicines. Conclusion: We observed increasing attention deficit hyperactivity disorder medicine use in Australia, especially among young females. Nevertheless, treatment rates remain lower than the estimated prevalence of attention deficit hyperactivity disorder across all subpopulations. Poor long-term treatment persistence in adolescence may warrant improved clinical monitoring of attention deficit hyperactivity disorder in patients transitioning from paediatric to adult care. Reassuringly, use of newly approved guanfacine appeared to be in accordance with guidelines among children.

Dispensing of psychotropic medications to Australian children and adolescents before and during the COVID‐19 pandemic, 2013–2021: a retrospective cohort study

“…Population‐based information on longitudinal patterns of psychotropic agent dispensing for children and adolescents in Australia is limited. Evidence for increasing psychotropic use is restricted to particular types (antidepressants 11 or psychostimulants 12 ) or is based on analyses of general practice data 13 . The objective of our study was therefore to determine longitudinal patterns of dispensing of antidepressant, anxiolytic, antipsychotic, psychostimulant, and hypnotic and sedative medicines to children and adolescents in Australia during 2013–2021.…”

A model of care for attention deficit and hyperactivity disorder among adults in the community

“…Despite the effectiveness and safety of treatment, especially medications, 12 ADHD among adults remains undertreated. 13 The IUIH Protocol represents a potentially effective model of care in the primary health sector. We are hopeful that with successful implementation, the rate of undiagnosed and untreated ADHD among Indigenous adults in South East Queensland will decrease.…”

“…Despite the effectiveness and safety of treatment, especially medications, 12 ADHD among adults remains undertreated. 13…”

Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases

“…Additionally, a substantial proportion of young individuals with ADHD continues to have impairing symptoms in adulthood, necessitating prolonged use of ADHD medication. Notably, studies have indicated a rising trend in the long-term use of ADHD medications, with approximately half of individuals using ADHD medication for over 5 years . Furthermore, evidence is lacking regarding how cardiovascular risk may vary based on factors such as type of CVD, type of ADHD medication, age, and sex .…”