title: Prescription Drug Use and Polypharmacy Among Medicaid-Enrolled Adults with Autism: A Retrospective Cross-Sectional Analysis.
abstract: BACKGROUND
  A 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.
  
  
  OBJECTIVE
  The 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).
  
  
  METHODS
  Adults 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.
  
  
  RESULTS
  Annually, 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%ASDvs 20%noASD), anticonvulsants (59%ASDvs 20%noASD), and anxiolytics/hypnotics/sedatives (21%ASDvs 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%ASDvs 32%noASD) and psychotropic polypharmacy (19%ASDvs 6%noASD) were significantly higher in the ASD group.
  
  
  CONCLUSIONS
  Prescription 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.
authors.affiliation: Center for Medication Optimization Through Practice and Policy, UNC Eshelman School of Pharmacy, 2401 Kerr Hall, Chapel Hill, NC, 27599, USA. rinievohra@gmail.com.|Department of Pharmaceutical Systems and Policy, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506 9510, USA. rinievohra@gmail.com.
authors.forename: Rini
authors.identifier: http://orcid.org/0000-0002-6322-8091
authors.initials: R
authors.lastname: Vohra
authors.affiliation: Department of Pharmaceutical Systems and Policy, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506 9510, USA.
authors.forename: Suresh
authors.initials: S
authors.lastname: Madhavan
authors.affiliation: Department of Pharmaceutical Systems and Policy, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506 9510, USA.
authors.forename: Usha
authors.initials: U
authors.lastname: Sambamoorthi
authors.affiliation: Behavior Analysis Program Area, West Virginia University, 1124 Life Sciences Building, Morgantown, WV, 26506-6040, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: StPeter
authors.affiliation: Department of Pediatrics, WVU School of Medicine, Klingberg Neurodevelopmental Center, West Virginia University, Morgantown, WV, 26506 9510, USA.|Autism/TRAIN, Center for Excellence in Disabilities (CED), Morgantown, WV, USA.
authors.forename: Susannah
authors.initials: S
authors.lastname: Poe
authors.affiliation: Department of Pharmaceutical Systems and Policy, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506 9510, USA.
authors.forename: Nilanjana
authors.initials: N
authors.lastname: Dwibedi
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Mayank
authors.initials: M
authors.lastname: Ajmera