title: Predictors of selecting atomoxetine therapy for children with attention-deficit-hyperactivity disorder.
abstract: 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.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  Managed care claims database.
  
  
  METHODS
  A total of 45,144 patients aged 18 years or younger who filled a prescription for an ADHD-specific drug.
  
  
  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).
  
  
  CONCLUSIONS
  Atomoxetine therapy was systematically preferred for patients with psychiatric comorbidities, contraindications to stimulants, or relatively heavy use of behavioral health care.
authors.affiliation: Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana 46285, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Van Brunt
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Johnston
authors.forename: Wenyu
authors.initials: W
authors.lastname: Ye
authors.forename: Gerhardt M
authors.initials: GM
authors.lastname: Pohl
authors.forename: Pei J
authors.initials: PJ
authors.lastname: Sun
authors.forename: Kimberly L
authors.initials: KL
authors.lastname: Sterling
authors.forename: Martha E
authors.initials: ME
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000523:psychology; D002648:Child; D002652:Child Behavior / Q000187:drug effects; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008329:Managed Care Programs; D011437:Propylamines / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D011437:Propylamines; D000069445:Atomoxetine Hydrochloride