The Definition and Prevalence of Pediatric Psychotropic Polypharmacy

Chen, Hua; Patel, Ankur; Sherer, Jeffrey T.; Aparasu, Rajender R.

doi:10.1176/appi.ps.000642011

Cited by 35 publications

(48 citation statements)

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“…A few studies among adults with ASD have examined psychotropic polypharmacy, but are restricted by small samples and clinical settings with a high chance of referral bias [19, 20]. Previous studies have defined polypharmacy in many different ways [16, 17, 18, 42, 43, 44] and variability in polypharmacy rates has been observed with differences in operational definitions in administrative claims databases [45]. Some have defined it as concurrent use of multiple drugs with minor (two drugs) and major (more than four drugs) differentiations [16–18] and some have defined it as use of more drugs that are clinically indicated or excessive use of inappropriate drugs [16, 42].…”

Section: Introductionmentioning

confidence: 99%

Prescription Drug Use and Polypharmacy Among Medicaid-Enrolled Adults with Autism: A Retrospective Cross-Sectional Analysis

Vohra

Madhavan

Sambamoorthi

et al. 2016

Drugs - Real World Outcomes

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BackgroundA lack of gold standard treatment for autism spectrum disorders (ASD), no clear ASD management guidelines, and lack of evidence-based pharmacological interventions other than aripiprazole and risperidone elevate the risk of off-label prescribing and adverse effects among individuals with ASD, more so among adults.ObjectiveThe aim of this study was to identify and compare the types of prescription drug use, rates of polypharmacy, and characteristics associated with polypharmacy among adults with and without ASD in a retrospective cross-sectional analysis of a three-state Medicaid Analytic eXtract database (2000–2008).MethodsAdults aged 22–64 years with ASD (ICD9-CM code: 299.xx) were propensity score-matched to ‘no ASD’ controls by age, sex, and race. General polypharmacy (≥6 unique classes of prescription drugs in a year) and psychotropic polypharmacy (≥3 unique prescription drug classes of psychotropic medications within a 90-day period) were the main study outcomes. Chi-square tests for rates, t tests for mean number of claims, and multivariate logistic regressions for likelihood of prescription drug use and polypharmacy were run.ResultsAnnually, almost 75% of adults with ASD had >20 prescription drug claims compared with 33% of adults without ASD. Around 85% of adults with ASD used at least one psychotropic drug class compared with 42% of adults without ASD. Highly common psychotropics were antipsychotics (66%ASD vs 20%noASD), anticonvulsants (59%ASD vs 20%noASD), and anxiolytics/hypnotics/sedatives (21%ASD vs 11%noASD). Other than psychotropics, many adults with ASD used medical prescription drugs such as antimicrobials (47%), dermatologic agents (48%), respiratory agents (38%), gastrointestinal agents (31%), alternative medications (25%), antiparkinsonian agents (22.6%), antihyperlipidemics/statins (7.3%), and immunologics (2.0%). Rates of general (48%ASD vs 32%noASD) and psychotropic polypharmacy (19%ASD vs 6%noASD) were significantly higher in the ASD group.ConclusionPrescription drug use and polypharmacy rates among adults with ASD are substantially higher than those in an age-, sex-, and race-matched cohort of adults without ASD. Adults with ASD frequently use therapeutic treatments other than psychotropics. Healthcare providers, who usually report low confidence in treating patients with ASD, should play an active role in constant monitoring of prescription drug use patterns and patient response to interventions. Prescribers and caregivers are encouraged to make decisions after weighing the benefits and risks associated with a pharmacological treatment. Further investigations into the common use of any alternative treatments that can affect a patient’s response to core treatments should also be conducted.Electronic supplementary materialThe online version of this article (doi:10.1007/s40801-016-0096-z) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Prescription Drug Use and Polypharmacy Among Medicaid-Enrolled Adults with Autism: A Retrospective Cross-Sectional Analysis

Vohra

Madhavan

Sambamoorthi

et al. 2016

Drugs - Real World Outcomes

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“…Research shows increasing rates of psychotropic use and the simultaneous use of multiple psychotropic medications (polypharmacy) among children overall [1][2][3][4][5] and in children with autism spectrum disorders (ASD). [6][7][8][9][10][11][12] General concerns about these medications include the lack of evidence documenting the safety or effectiveness of psychotropic treatment during childhood, when developing brains and bodies may be particularly vulnerable to environmental or biological influences.…”

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confidence: 99%

Psychotropic Medication Use and Polypharmacy in Children With Autism Spectrum Disorders

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Psychotropic use is common and increasing in children with mental disorders but little is known about the long-term patterns of psychotropic use and polypharmacy among commercially insured children with autism spectrum disorders. WHAT THIS STUDY ADDS:Among 33 565 children with autism spectrum disorders, 64% used psychotropic medications and 35% had evidence of polypharmacy. Older children and those who had seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression had increased risk of psychotropic use and polypharmacy.abstract OBJECTIVE: The objectives of this study were to examine rates and predictors of psychotropic use and multiclass polypharmacy among commercially insured children with autism spectrum disorders (ASD).METHODS: This retrospective observational study used administrative medical and pharmacy claims data linked with health plan enrollment and sociodemographic information from 2001 to 2009. Children with ASD were identified by using a validated ASD case algorithm. Psychotropic polypharmacy was defined as concurrent medication fills across $2 classes for at least 30 days. Multinomial logistic regression was used to model 5 categories of psychotropic use and multiclass polypharmacy. RESULTS:Among 33 565 children with ASD, 64% had a filled prescription for at least 1 psychotropic medication, 35% had evidence of psychotropic polypharmacy ($2 classes), and 15% used medications from $3 classes concurrently. Among children with polypharmacy, the median length of polypharmacy was 346 days. Older children, those who had a psychiatrist visit, and those with evidence of cooccurring conditions (seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression) had higher odds of psychotropic use and/or polypharmacy.CONCLUSIONS: Despite minimal evidence of the effectiveness or appropriateness of multidrug treatment of ASD, psychotropic medications are commonly used, singly and in combination, for ASD and its cooccurring conditions. Our results indicate the need to develop standards of care around the prescription of psychotropic medications to children with ASD. Pediatrics 2013;132:833-840

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“…It is estimated that between 27.2% and 52.0% of children in outpatient settings and up to 85% in inpatient and residential settings are prescribed two or more psychotropic medications (1–6). Across payer groups, rates are generally higher for publicly rather than privately insured children and for children in foster care compared with the general population (2,7).…”

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confidence: 99%

“…First, among youths prescribed any medication, what are the rates of multiple medication use for each eligibility group, and have they increased over time? To facilitate comparisons with other studies, often difficult to reconcile because of variations in how polypharmacy is defined (1,21), estimates are presented for several operationalizations of polypharmacy. Second, with controls for demographic and clinical characteristics, have polypharmacy rates increased differentially across eligibility groups?…”

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confidence: 99%

Trends in Psychotropic Polypharmacy Among Youths Enrolled in Ohio Medicaid, 2002–2008

Fontanella¹,

Warner²,

Phillips³

et al. 2014

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Objective This study examined polypharmacy patterns and rates over time among Medicaid-enrolled youths by comparing three enrollment groups (youths in foster care, with a disability, or from a family with low income). Methods Serial cross-sectional trend analyses of Medicaid claims data were conducted for youths age 17 and younger who were continuously enrolled in Ohio Medicaid for a one-year period and prescribed one or more psychotropic medications during fiscal years 2002 (N=26,252) through 2008 (N=50,311). Outcome measures were any polypharmacy (three or more psychotropic medications from any drug class) and multiclass polypharmacy (three or more psychotropic medications from different drug classes). Results Both types of polypharmacy increased across all three eligibility groups. Any polypharmacy increased from 8.8% to 11.5% for low-income youths (adjusted odds ratio [AOR]=1.12, 99% confidence interval [CI]=1.10–1.13), from 18.0% to 24.9% for youths with a disability (AOR=1.11, CI=1.09–1.13), and from 19.8% to 27.3% for youths in foster care (AOR=1.09, CI=1.07–1.11). Combinations associated with positive increases were two or more antipsychotics, two or more stimulants, and antipsychotics with stimulants. Conclusions Polypharmacy increased across all enrollment groups, with the highest absolute rates for youths in foster care. Both the overall prevalence and increases in prescriptions for drug combinations with limited evidence of safety and efficacy, such as the prescription of two or more antipsychotics, underscore the need for targeted quality improvement efforts. System oversight and monitoring of psychotropic medication use appears to be warranted, especially for higher-risk groups, such as youths in foster care and those from low-income households who were prescribed multiple antipsychotics.

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The Definition and Prevalence of Pediatric Psychotropic Polypharmacy

Abstract: The observed rate of polypharmacy dropped with increasingly stringent operational definitions for polypharmacy. The findings suggest that considerable differences arise when comparing rates of polypharmacy across studies with inconsistent operational definitions.

Cited by 35 publications

References 28 publications

Prescription Drug Use and Polypharmacy Among Medicaid-Enrolled Adults with Autism: A Retrospective Cross-Sectional Analysis

Prescription Drug Use and Polypharmacy Among Medicaid-Enrolled Adults with Autism: A Retrospective Cross-Sectional Analysis

Psychotropic Medication Use and Polypharmacy in Children With Autism Spectrum Disorders

Trends in Psychotropic Polypharmacy Among Youths Enrolled in Ohio Medicaid, 2002–2008

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