Study on drug retention of methylphenidate and atomoxetine in children with attention-deficit/hyperactivity disorder

盐酸哌甲酯和盐酸托莫西汀在注意缺陷多动障碍儿童中的用药保留率研究

This study retrospectively analyzed the medication prescriptions of children diagnosed with attention-deficit/hyperactivity disorder(ADHD) in Ningbo Psychiatric Hospital and Ningbo Women and Children’s Hospital from March 2018 to September 2020 and compared the drug retention rate of methylphenidate hydrochloride and atomoxetine hydrochloride. The prescription automatic screening system was used to screen the prescriptions in children with ADHD. Kaplan-Meier regression analysis was used to compare prescription retention rates between the two regimens after adjusting for gender, age, body weight, and prescription cost. The mean age of the methylphenidate hydrochloride group was 8.75 ± 2.16 years, and the monthly prescription cost was 327.37 ± 146.64 RMB. The average age of the atomoxetine group was 8.33 ± 1.73 years, and the monthly prescription cost was 363.15 ± 154.90 ￥. There were some differences in the age of enrollment and the monthly prescription cost between the two regimens(all P < 0.01). Moreover, the retention rate of methylphenidate hydrochloride was higher compared with atomoxetine hydrochloride within 18 months. Kaplan-Meier regression analysis showed that this trend was significant(Tarone-ware, Chi-square value = 14.893, P < 0.001). Prescription costs might be a factor affecting drug retention. This study found that the retention rates were decreased month by month in children with ADHD, and after 5 months, the retention rates were 52.20% and 41.22%, respectively, far below the recommended levels of the guidelines.

本文回顾性分析了宁波市精神病院和宁波市妇女儿童医院2018年3月至2020年9月诊断为注意缺陷多动障碍儿童的用药处方,比较了盐酸哌甲酯和盐酸托莫西汀治疗时的药物保留率情况。应用医院合理用药管理系统筛选诊断为儿童注意缺陷多动障碍的处方。在调整性别、年龄、体重以及处方费用四个系数之后,应用Kaplan-Meier回归分析比较两种用药方案的处方保留率。盐酸哌甲酯组平均年龄为8.75±2.16岁,每月处方费用为327.37±146.64元;托莫西汀组平均年龄为8.33±1.73岁,每月处方费用为363.15±154.90元。两种药物方案的入组年龄和每月处方费用存在一定的差异(均P<0.01)。对比两种治疗药物的用药保留率,盐酸哌甲酯在18个月内的用药保留率均高于盐酸托莫西汀方案,经Kaplan-Meier回归分析,这种趋势具有显著意义(Tarone-Ware,卡方值=14.893,P<0.001),处方费用可能是影响药物保留率的一个因素。本研究发现,注意缺陷多动障碍儿童应用药物治疗时,保留率逐月下降;5个月后两者的保留率分别为52.20%和41.22%,远远低于指南的推荐水平。