Treatment outcomes after methylphenidate in adults with attention-deficit/hyperactivity disorder treated with lisdexamfetamine dimesylate or atomoxetine

Alain Joseph, Martin Cloutier, Annie Guérin, Roy Nitulescu, Vanja Sikirica, Alain Joseph, Martin Cloutier, Annie Guérin, Roy Nitulescu, Vanja Sikirica

Abstract

Purpose: To compare treatment adherence, discontinuation, add-on, and daily average consumption (DACON) among adults with attention-deficit/hyperactivity disorder receiving second-line lisdexamfetamine dimesylate (LDX) or atomoxetine (ATX), following methylphenidate.

Patients and methods: A retrospective cohort study using US commercial claims databases (Q2/2009-Q3/2013).

Results: At month 12, the LDX cohort (N=2,718) had a higher adherence level (proportion of days covered: 0.48 versus 0.30, P<0.001) and was less likely to discontinue (Kaplan-Meier estimate: 63% versus 85%, P<0.001) than the ATX cohort (N=674). There were no statistical differences in treatment add-on rates between cohorts (Kaplan-Meier estimate: 26% versus 25%, P=0.297). The LDX cohort had a lower DACON (1.10 versus 1.31, P<0.001) and was less likely to have a DACON >1 (adjusted odds ratio: 0.20, 95% confidence interval: 0.15-0.25, P<0.001) than the ATX cohort.

Conclusion: Adults with attention-deficit/hyperactivity disorder treated with LDX following methylphenidate had a higher treatment adherence and lower discontinuation and DACON relative to those treated with ATX following methylphenidate.

Keywords: ADHD; adherence; adult; atomoxetine; lisdexamfetamine dimesylate.

Figures

Figure 1
Figure 1
Kaplan-Meier estimates and hazard ratios for treatment discontinuation. Notes: *Significant at the 5% level. No multiplicity adjustment was performed, so the P-values need to be interpreted with caution. Total number of LDX patients, N=2,718; Total number of ATX patients, N=674. Abbreviations: ATX, atomoxetine; CI, confidence interval; KM, Kaplan–Meier; LDX, lisdexamfetamine dimesylate; HR, hazard ratio.
Figure 2
Figure 2
Kaplan–Meier estimates and hazard ratios for treatment add-on. Notes: *Significant at the 5% level. No multiplicity adjustment was performed, so the P-values need to be interpreted with caution. Total number of LDX patients, N=2,718; Total number of ATX patients, N=674. Abbreviations: ATX, atomoxetine; CI, confidence interval; KM, Kaplan–Meier; LDX, lisdexamfetamine dimesylate; HR, hazard ratio.

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