title: Persistence of pharmacological treatment into adulthood, in UK primary care, for ADHD patients who started treatment in childhood or adolescence.
abstract: BACKGROUND
  ADHD guidelines in the UK suggest that children and adults who respond to pharmacological treatment should continue for as long as remains clinically effective, subject to regular review. To what extent patients persist with treatment from childhood and adolescence into adulthood is not clear. This study aims to describe, in UK primary care, the persistence of pharmacological treatment for patients with ADHD who started treatment aged 6-17 years and to estimate the percentage of patients who continued treatment from childhood and adolescence into adulthood.
  
  
  METHODS
  The Health Improvement Network (THIN) database was used to identify patients with ADHD who received their first prescription for methylphenidate/ dexamfetamine/atomoxetine, aged 6-17 years. Patients were monitored until their 'censored date' (the earliest of the following dates: date the last prescription coded in the database ended, end of the study period (31st December 2008), date at which they transferred out of their practice, date of death, the last date the practice contributed data to the database). Persistence of treatment into adulthood was estimated using Kaplan Meier analysis.
  
  
  RESULTS
  610 patients had follow-up data into adulthood. 213 patients (93.4% male) started treatment between 6-12 years; median treatment duration 5.9 years. 131 (61.5%) stopped before 18 years, 82 (38.5%) were still on treatment age ≥18 years. 397 patients (86.4% male) started treatment between 13-17 years; median treatment duration was 1.6 years. 227 (57.2%) stopped before 18 years, 170 (42.8%) were still on treatment age ≥18 years. The number of females in both age categories was too small to formally test for differences between genders in persistence of treatment.
  
  
  CONCLUSIONS
  Persistence of treatment into adulthood is lower (~40%) compared with published rates of persistence of the condition (~65% when symptomatic definition of remission used). Due to the limited number of patients with data past 18 years, it is important that ongoing monitoring of prescribing into later adulthood is undertaken, particularly to observe the effects of recommendations in new guidelines.
authors.affiliation: School of Pharmacy, University College Cork, Cork, Ireland. s.mccarthy@ucc.ie
authors.forename: Suzanne
authors.initials: S
authors.lastname: McCarthy
authors.forename: Lynda
authors.initials: L
authors.lastname: Wilton
authors.forename: Macey L
authors.initials: ML
authors.lastname: Murray
authors.forename: Paul
authors.initials: P
authors.lastname: Hodgkins
authors.forename: Philip
authors.initials: P
authors.lastname: Asherson
authors.forename: Ian C K
authors.initials: IC
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000523:psychology*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D003913:Dextroamphetamine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011437:Propylamines / Q000627:therapeutic use; D006113:United Kingdom
chemical_list: D000697:Central Nervous System Stimulants; D011437:Propylamines; D008774:Methylphenidate; D000069445:Atomoxetine Hydrochloride; D003913:Dextroamphetamine