Brikell, Isabell, Yao, Honghui, Li, Lin, Astrup, Aske, Gao, Le, Gillies, Malcolm B., Xie, Tian, Zhang-James, Yanli, Dalsgaard, Søren, Engeland, Anders, Faraone, Stephen V., Haavik, Jan, Hartman, Catharina, Ip, Patrick, Jakobsdóttir Smári, Unnur, Larsson, Henrik, Man, Kenneth K.C., de Oliveira Costa, Juliana, Pearson, Sallie Anne, Hostrup Nielsen, Nina Pil, Snieder, Harold, Wimberley, Theresa, Wong, Ian C.K., Zhang, Le, Zoega, Helga, Klungsøyr, Kari and Chang, Zheng (2024). ADHD medication discontinuation and persistence across the lifespan:a retrospective observational study using population-based databases. The Lancet Psychiatry, 11 (1), pp. 16-26.
Abstract
Background: Although often intended for long-term treatment, discontinuation of medication for ADHD is common. However, cross-national estimates of discontinuation are missing due to the absence of standardised measures. The aim of this study was to determine the rate of ADHD treatment discontinuation across the lifespan and to describe similarities and differences across countries to guide clinical practice. Methods: We did a retrospective, observational study using population-based databases from eight countries and one Special Administrative Region (Australia, Denmark, Hong Kong, Iceland, the Netherlands, Norway, Sweden, the UK, and the USA). We used a common analytical protocol approach and extracted prescription data to identify new users of ADHD medication. Eligible individuals were aged 3 years or older who had initiated ADHD medication between 2010 and 2020. We estimated treatment discontinuation and persistence in the 5 years after treatment initiation, stratified by age at initiation (children [age 4–11 years], adolescents [age 12–17 years], young adults [age 18–24 years], and adults [age ≥25 years]) and sex. Ethnicity data were not available. Findings: 1 229 972 individuals (735 503 [60%] males, 494 469 females [40%]; median age 8–21 years) were included in the study. Across countries, treatment discontinuation 1–5 years after initiation was lowest in children, and highest in young adults and adolescents. Within 1 year of initiation, 65% (95% CI 60–70) of children, 47% (43–51) of adolescents, 39% (36–42) of young adults, and 48% (44–52) of adults remained on treatment. The proportion of patients discontinuing was highest between age 18 and 19 years. Treatment persistence for up to 5 years was higher across countries when accounting for reinitiation of medication; at 5 years of follow-up, 50–60% of children and 30–40% of adolescents and adults were covered by treatment in most countries. Patterns were similar across sex. Interpretation: Early medication discontinuation is prevalent in ADHD treatment, particularly among young adults. Although reinitiation of medication is common, treatment persistence in adolescents and young adults is lower than expected based on previous estimates of ADHD symptom persistence in these age groups. This study highlights the scope of medication treatment discontinuation and persistence in ADHD across the lifespan and provides new knowledge about long-term ADHD medication use. Funding: European Union Horizon 2020 Research and Innovation Programme.
Publication DOI: | https://doi.org/10.1016/S2215-0366(23)00332-2 |
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Divisions: | College of Health & Life Sciences > Aston Pharmacy School |
Funding Information: | This study was funded by the European Union Horizon 2020 Research and Innovation Programme (grant 965381). This research reflects only the authors' view, and the European Commission is not responsible for any use that may be made of the information it con |
Additional Information: | Copyright © 2024 Elsevier Ltd. This accepted manuscript version is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License [https://creativecommons.org/licenses/by-nc-nd/4.0/]. |
Uncontrolled Keywords: | Adolescent,Adult,Attention Deficit Disorder with Hyperactivity/drug therapy,Central Nervous System Stimulants/therapeutic use,Child,Child, Preschool,Female,Humans,Longevity,Male,Netherlands,Retrospective Studies,Young Adult |
Publication ISSN: | 2215-0374 |
Last Modified: | 07 Jul 2025 11:53 |
Date Deposited: | 07 Jul 2025 11:53 |
Full Text Link: | |
Related URLs: |
https://www.sci ... 215036623003322
(Publisher URL) http://www.scop ... tnerID=8YFLogxK (Scopus URL) |
PURE Output Type: | Article |
Published Date: | 2024-01 |
Published Online Date: | 2023-11-27 |
Accepted Date: | 2023-11-01 |
Authors: |
Brikell, Isabell
Yao, Honghui Li, Lin Astrup, Aske Gao, Le Gillies, Malcolm B. Xie, Tian Zhang-James, Yanli Dalsgaard, Søren Engeland, Anders Faraone, Stephen V. Haavik, Jan Hartman, Catharina Ip, Patrick Jakobsdóttir Smári, Unnur Larsson, Henrik Man, Kenneth K.C. de Oliveira Costa, Juliana Pearson, Sallie Anne Hostrup Nielsen, Nina Pil Snieder, Harold Wimberley, Theresa Wong, Ian C.K. ( ![]() Zhang, Le Zoega, Helga Klungsøyr, Kari Chang, Zheng |