Effect of methylphenidate formulation for attention deficit hyperactivity disorder on patterns and outcomes of treatment

Objectives: The aim of this study was to assess whether once-daily Concerta(R) extended-release (XR) methylphenidate (MPH) is associated with: (1) better compliance; (2) decreased likelihood of. accidents/injuries; and (3) lower health-care resource use over a 1-year period than 3-times-daily immediate-release (IR) MPH in children with attention deficit hyperactivity disorder (ADHD). Methods: Multivariate regression analyses were performed using an administrative database. Inclusion criteria were: (1) an age of 6-12 years at the date of first prescription for XR/IR MPH (index date); (2) patient-level data available for least 6 months before and 12 months after the index date; (3) no ADHD medications in the 6-month prior period; and (4) no XR MPH use by the IR MPH group. Results: IR MPH: n = 344, mean age 9.55 years, 76% male; XR MPH: n = 1431, mean age 9.78 years, 75% male. XR MPH patients were less likely to discontinue, less likely to switch, and more likely to persist (i.e., no gaps > 14 days) with therapy (p < 0.0001). Children receiving XR MPH were less likely to experience an accident or injury (OR = 0.58, 95% CI 0.353-0.945). Use of XR MPH was associated with significantly fewer emergency room visits and general practitioner visits per patient, on average, over 1 year. Conclusions: These data support the use of XR MPH with its simplified dosing regimen for children with ADHD.