title: Initiation and Persistence of Pharmacotherapy for Youths with Attention Deficit Hyperactivity Disorder in Taiwan.
abstract: BACKGROUND
  Pharmacotherapy is an effective therapeutic option for attention deficit hyperactivity disorder (ADHD). Understanding the patterns of medication treatment is crucial for clinical practice. This study employed nationwide population-based data to elucidate the initiation and persistence of pharmacotherapy (immediate-release methylphenidate [IR-MPH], osmotic controlled-release formulations of methylphenidate [OROS-MPH] and atomoxetine [ATX]) for youths with ADHD in Taiwan.
  
  
  METHODS
  Patients first receiving an ADHD diagnosis at age 18 or younger between January 2000 and December 2009 (n = 112,140; mean age at ADHD diagnosis: 7.7 years) were selected from Taiwan's National Health Insurance database. All patients were monitored through December 31, 2011, with an average follow-up time of 5.8 years. The initiation of ADHD drug therapy was defined as the first patient prescription, and discontinuation was defined as the cessation of ADHD medication for 180 days or longer.
  
  
  RESULTS
  Within the first year after ADHD diagnosis, 47.3%, 14.4%, and 0.8% of the patients were prescribed IR-MPH, OROS-MPH, and ATX, respectively. Regarding the patients prescribed IR-MPH, OROS-MPH, and ATX, 17.8%, 12.6%, and 18.8%, respectively, received the prescription only once and never returned for a drug refill, and 51.0%, 38.9%, and 58.8%, respectively, discontinued drug therapy within 1 year after the first prescription. Male sex and neuropsychiatric comorbidities were associated with higher probabilities of being prescribed one of the medications. An older age at first prescription and a higher daily dose of prescription were significant predictors of early discontinuation of ADHD medication.
  
  
  CONCLUSIONS
  The current findings suggest that IR-MPH is the most frequently prescribed drug for ADHD treatment in Taiwan. Patients treated with OROS-MPH possessed the highest persistence rate, whereas those treated with ATX had the lowest persistence rate. The results provide insight into the delivery of pediatric mental health services and have crucial implications for ADHD medication treatment in real clinical settings.
authors: Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors: Liang-Jen
authors: LJ
authors: Wang
authors: Genome and Systems Biology Degree Program, National Taiwan University and Academia Sinica, Taipei, Taiwan.|Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
authors: Kang-Chung
authors: KC
authors: Yang
authors: Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan.
authors: Sheng-Yu
authors: SY
authors: Lee
authors: Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan.|Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
authors: Chun-Ju
authors: CJ
authors: Yang
authors: Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.|Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.|Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Ting-Shuo
authors: TS
authors: Huang
authors: Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
authors: Tung-Liang
authors: TL
authors: Lee
authors: Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
authors: Shin-Sheng
authors: SS
authors: Yuan
authors: Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.|Institute of Molecular Biology, Academia Sinica, Nankang, Taipei, Taiwan.
authors: Yu-Chiau
authors: YC
authors: Shyu
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D013624:Taiwan; D016903:Drug Monitoring
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate