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Physicians More Likely to Prescribe Atomoxetine than Stimulants for ADHD in Adults with Other Psychiatric Diagnoses: Presented at AACAP

By Paula Moyer

TORONTO, CANADA -- November 1, 2005 -- Physicians are more likely to prescribe atomoxetine (Strattera) than stimulants to adults with attention deficit hyperactivity disorder (ADHD) if the patient has additional psychiatric diagnoses, according to investigators who presented their findings here at the joint meeting of the American and Canadian Academies of Child and Adolescent Psychiatry (AACAP/CACAP).

"We wanted to see if an ADHD patient's history predicted whether or not the patient was steered toward stimulant therapies or a non-stimulant ADHD therapy, such as atomoxetine or buproprion," said principal investigator David L. Van Brunt, PhD, Research Scientist, Eli Lilly and Company, Indianapolis, Indiana, United States.

"Complicating factors of treatment-- like histories of anxiety, depression, other psychiatric comorbidities such as substance abuse risk -- predicted whether physicians would prescribe atomoxetine as opposed to stimulant therapies," Dr. Brunt said during his presentation on October 20^th.

"Conversely, stimulants were used in patients who had had a prior use of stimulants," he added, noting the logic of persisting with successful therapy.

Medical comorbidities, such as hypertension and cardiac arrhythmia, were not predictive, he said.

The investigators conducted the study because of growing evidence that ADHD persists into adulthood. Therefore, they reviewed pharmacy and medial administrative claims from a database that included 10,359 patients who were 18 years old or more and had begun both an ADHD-specific medication and had filed at least one diagnostic claim for ADHD between 2002 and 2003.

The investigators compared treatment initiations within the previous 3 months of atomoxetine and any stimulant and atomoxetine or a long-acting stimulant. In the analysis comparing treatment initiations for atomoxetine to any stimulant, 2036 patients had most recently started on atomoxetine and 6814 had most recently started on any stimulant. For the analysis comparing treatment initiations for atomoxetine to long-acting stimulants, 1956 patients had most recently initiated atomoxetine and 3567 had most recently started a long-acting stimulant.

In the analysis of atomoxetine and any stimulant, the key factor that predicted the use of a stimulant was use of a stimulant in the previous year, which occurred in more than 60% of cases. Several other factors tended to influence prescriptions of atomoxetine -- prior use of buproprion (Wellbutrin), which is often used off-label for adult ADHD; any antidepressant; any antipsychotic; the use of mood stabilizers and anxiolytics; and visits to a behavioral health clinic.

There was no overall difference in prescribing patterns of all stimulants and long-acting stimulants, Dr. Brunt said.

"The findings suggest that, to some degree, stimulants and atomoxetine are being used to address different treatment needs in clinical practice," he said.

Eli Lilly and Company manufactures Strattera and funded the study.


[Presentation title: Factors Predicting Atomoxetine Treatment Initiation for Adults with ADHD.]

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