REAL-WORLD EVIDENCE STUDY OF TREATMENT PATTERNS IN PEDIATRIC AND ADULT PATIENTS WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER IN ALBERTA
Author(s)
Yang S. Liu, PhD1, Pratap Chokka, MD1, Phong Manivong, PhD2, Eileen Shaw, BSc, MSc2, Tram Pham, MPH2, Maxime Rouleau, BA3, Matthieu Boucher, PhD3, Khalid Lakhdari, MBA, MSc3.
1Department of Psychiatry, University of Alberta, Edmonton, AB, Canada, 2Medlior Health Outcomes Research Ltd., Calgary, AB, Canada, 3Otsuka Canada Pharmaceutical Inc., Saint-Laurent, QC, Canada.
1Department of Psychiatry, University of Alberta, Edmonton, AB, Canada, 2Medlior Health Outcomes Research Ltd., Calgary, AB, Canada, 3Otsuka Canada Pharmaceutical Inc., Saint-Laurent, QC, Canada.
OBJECTIVES: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder treated with pharmacological and behavioral interventions. Traditional pharmacological treatments include stimulant drugs such as methylphenidate and amphetamines, and non-stimulants including atomoxetine and guanfacine. Population-level, real-world evidence on ADHD treatment patterns in Canada remains limited. This study characterized treatment patterns among patients with ADHD in Alberta, including lines of therapy, reasons for discontinuation, and treatment persistence for the index regimen.
METHODS: A retrospective, observational study was conducted using administrative health data from Alberta, Canada. Patients aged ≥6 years diagnosed with ADHD who initiated first-line therapy between April 2017 and September 2023 were included and followed until March 2024. Treatment regimens received were identified using pharmacy dispensations. Discontinuation was defined as a gap of ≥180 days. Switching was defined as dispensing a new agent ≥30 days after discontinuation or with <30 days overlap in supply with the discontinued agent. Reasons for discontinuation were proxied as: adverse event (AE), treatment failure (discontinuation/switch without an AE), or other. Treatment patterns were analyzed descriptively, while treatment persistence was analyzed using Kaplan-Meier methods.
RESULTS: The study cohort included 79,999 patients who received first-line therapy; 27,329 and 8,375 received second- and third-line therapies, respectively. For both the first- and second- line, lisdexamfetamine dimesylate and long-acting methylphenidate hydrochloride were the most common regimens (50.4% and 34.7% for first-line and 28.7% and 27.0% for second-line, respectively). Third-line therapy included similar use of these agents, mixed salts amphetamine extended-release, stimulant/non-stimulant combinations, and stimulant combinations. Across therapy lines, most discontinuations/switches were associated with proxied AEs (66.7-80.8% of those who discontinued/switched). One quarter of patients discontinued/switched their first-line therapy within 28 months, and 42.4% of patients discontinued/switched within 84 months (maximum follow-up).
CONCLUSIONS: These findings provide real-world evidence on ADHD treatment patterns in Canada and may inform clinical decision-making and future evaluations of treatment effectiveness and tolerability.
METHODS: A retrospective, observational study was conducted using administrative health data from Alberta, Canada. Patients aged ≥6 years diagnosed with ADHD who initiated first-line therapy between April 2017 and September 2023 were included and followed until March 2024. Treatment regimens received were identified using pharmacy dispensations. Discontinuation was defined as a gap of ≥180 days. Switching was defined as dispensing a new agent ≥30 days after discontinuation or with <30 days overlap in supply with the discontinued agent. Reasons for discontinuation were proxied as: adverse event (AE), treatment failure (discontinuation/switch without an AE), or other. Treatment patterns were analyzed descriptively, while treatment persistence was analyzed using Kaplan-Meier methods.
RESULTS: The study cohort included 79,999 patients who received first-line therapy; 27,329 and 8,375 received second- and third-line therapies, respectively. For both the first- and second- line, lisdexamfetamine dimesylate and long-acting methylphenidate hydrochloride were the most common regimens (50.4% and 34.7% for first-line and 28.7% and 27.0% for second-line, respectively). Third-line therapy included similar use of these agents, mixed salts amphetamine extended-release, stimulant/non-stimulant combinations, and stimulant combinations. Across therapy lines, most discontinuations/switches were associated with proxied AEs (66.7-80.8% of those who discontinued/switched). One quarter of patients discontinued/switched their first-line therapy within 28 months, and 42.4% of patients discontinued/switched within 84 months (maximum follow-up).
CONCLUSIONS: These findings provide real-world evidence on ADHD treatment patterns in Canada and may inform clinical decision-making and future evaluations of treatment effectiveness and tolerability.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD83
Topic
Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
Neurological Disorders