Combined Medication with Stimulants and Non-stimulants for Attention-deficit/hyperactivity Disorder
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Objective: To study the efficiency and indication of combined medication with a stimulant and non-stimulant for attention- deficiency/hyperactivity disorder (ADHD), herein, the authors examined children and adult patients with ADHD. Methods: Subjects included patients diagnosed with ADHD who paid two or more visits to the outpatient clinic of the Kyung Hee University hospital from January 2009 to December 2019. The authors examined the age, sex, drugs, treatment adherence, and reason for combined medication. The subjects were classified into four groups: treatment with a non-stimulant (atomoxetine) only (Group ATX), treatment with a stimulant (methylphenidate immediate-release, extended-release, or osmotic-release oral system) only (Group MPH), exposed to both but separately used (Group SEP), and exposed to both with combined use (Group COM). The patient was considered adherent to treatment (1) on visiting the hospital ten or more times or consecutively for six months, and (2) medication possession ratio ≥ 0.8. Results: Of 929 patients, 229 (24.7%) were female. Group ATX comprised 146 (15.7%) patients, Group MPH comprised 627 (67.5%) patients, Group SEP comprised 106 (11.4%) patients, and Group COM comprised 50 (5.4%) patients. Longer-term adherence was seen with combined medication and in females than with monopharmacy and in males. The main indication for combination was dose-limiting untoward effects. Conclusion: These results suggest that combined medication would facilitate treatment adherence for ADHD. Further research is essential for the replication of these results in a large sample and the investigation of the indications for administering combined medication in children and adults with ADHD.
Abstract
Objective: To study the efficiency and indication of combined medication with a stimulant and non-stimulant for attention- deficiency/hyperactivity disorder (ADHD), herein, the authors examined children and adult patients with ADHD. Methods: Subjects included patients diagnosed with ADHD who paid two or more visits to the outpatient clinic of the Kyung Hee University hospital from January 2009 to December 2019. The authors examined the age, sex, drugs, treatment adherence, and reason for combined medication. The subjects were classified into four groups: treatment with a non-stimulant (atomoxetine) only (Group ATX), treatment with a stimulant (methylphenidate immediate-release, extended-release, or osmotic-release oral system) only (Group MPH), exposed to both but separately used (Group SEP), and exposed to both with combined use (Group COM). The patient was considered adherent to treatment (1) on visiting the hospital ten or more times or consecutively for six months, and (2) medication possession ratio ≥ 0.8. Results: Of 929 patients, 229 (24.7%) were female. Group ATX comprised 146 (15.7%) patients, Group MPH comprised 627 (67.5%) patients, Group SEP comprised 106 (11.4%) patients, and Group COM comprised 50 (5.4%) patients. Longer-term adherence was seen with combined medication and in females than with monopharmacy and in males. The main indication for combination was dose-limiting untoward effects. Conclusion: These results suggest that combined medication would facilitate treatment adherence for ADHD. Further research is essential for the replication of these results in a large sample and the investigation of the indications for administering combined medication in children and adults with ADHD.
참고문헌 (24)
- Adler LA, "Combination pharmacotherapy for adult ADHD", Curr Psychiatry Rep, 8, pp.409~415 (2006)
- Toru Fujioka, "Advanced Test of Attention in Children with Attention-Deficit", Hyperactivity Disorder in Japan for Evaluation of Methylphenidate and Atomoxetine Effects, 2016, pp.14(1), 79~87[DOI]
- Greenhill LL, "Medication treatment strategies in the MTA Study : relevance to clinicians and researchers", J Am Acad Child Adolesc Psychiatry, 35, pp.1304~1313 (1996)
- Wagner KD, "Management of treatment refractory attentiondeficit", hyperactivity disorder in children and adolescents, 2002, pp.36, 130~142
- Kooij JJS, "Adult ADHD: diagnostic assessment and treatment" (2013), Springer
- Treuer T, "A systematic review of combination therapy with stimulants and atomoxetine for attention-deficit", hyperactivity disorder, including patient characteristics, treatment strategies, effectiveness, and tolerability, 2013, pp.23, 179~193
- Subcommittee on Attention-Deficit, "Hyperactivity Disorder", ADHD : clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit, Pediatrics, pp.2011, 128[DOI]
- 반건호, "Development of the Korean Practice Parameter for Adult Attention-Deficit", Hyperactivity Disorder, 2020, pp.31(1), 5~25[DOI]
- Carlson GA, "A pilot study for augmenting atomoxetine with methylphenidate : safety of concomitant therapy in children with attention-deficit", hyperactivity disorder, 2007, pp.1, 10~
- Brown TE, "Atomoxetine and stimulants in combination for treatment of attention deficit hyperactivity disorder : four case reports", J Child Adolesc Psychopharmacol, 14, pp.129~136 (2004)
- Ozbaran B, "Combined methylphenidate and atomoxetine pharmacotherapy in attention deficit hyperactivity disorder", World J Biol Psychiatry, 16, pp.619~624 (2015)
- American Psychiatric Association, "Diagnostic and statistical manual of mental disorders" (1994), American Psychiatric Publishing
- American Psychiatric Association, "Diagnostic and statistical manual of mental disorders" (2013), American Psychiatric Publishing
- 반건호, "주의력결핍 과잉행동장애 치료의 역사적 재조명 : 약물치료적 접근", 생물정신의학, 21(2), pp.37~48 (2014), 대한생물정신의학회
- 홍민하, "Naturalistic Pharmacotherapy Compliance among Pediatric Patients with Attention Deficit", Hyperactivity Disorder: a Study Based on Three-Year Nationwide Data, 2016, pp.31(4), 611~616[DOI]
- Pottegård A, "The use of medication against attention deficit", hyperactivity disorder in Denmark : a drug use study from a patient perspective, 2013, pp.69, 589~598
- van den Ban E, "Less discontinuation of ADHD drug use since the availability of long-acting ADHD medication in children, adolescents and adults under the age of 45 years in the Netherlands", Atten Defic Hyperact Disord, 2, pp.213~220 (2010)
- Zetterqvist J, "Stimulant and non-stimulant attention deficit", hyperactivity disorder drug use : total population study of trends and discontinuation patterns 2006-2009, 2013, pp.128, 70~77
- Hong M, "A 36 month naturalistic retrospective study of clinic-treated youth with attention-deficit", hyperactivity disorder, 2014, pp.24, 341~346
- Osland ST, "Pharmacological treatment for attention deficit hyperactivity disorder(ADHD)in children with comorbid tic disorders", Cochrane Database Syst Rev, 6, pp.CD007990~ (2018)
- 김효원, "주의력결핍 과잉행동장애 한국형 치료 권고안 개정안(III) - 약물치료 -", 소아 청소년 정신의학, 28(2), pp.70~83 (2017), 대한소아청소년 정신의학회[DOI]
- Muit JJ, "Pharmacotherapy of ADHD in adults with autism spectrum disorder : effectiveness and side effects", J Atten Disord, 24, pp.215~225 (2020)
- 김윤정, "주의력결핍 과잉행동장애 아동의 약물치료 순응도에 영향을 미치는 요인：후향적 연구", 소아 청소년 정신의학, 21(3), pp.174~181 (2010), 대한소아청소년 정신의학회
- Miller J, "Clinical guidance on pharmacotherapy for the treatment of attention-deficit hyperactivity disorder(ADHD)for people with intellectual disability", Expert Opin Pharmacother, 21, pp.1897~1913 (2020)