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Examining the heterogeneity of treatment patterns in attention deficit hyperactivity disorder among children and adolescents in the Texas Medicaid population: modeling suboptimal treatment response.

OBJECTIVES: To examine suboptimal response (SR) in attention deficit hyperactivity disorder (ADHD) among pediatric patients in the Texas Medicaid program receiving osmotic-release oral system methylphenidate (OROS-MPH) or lisdexamfetamine (LDX) and apply an SR prediction model to identify patients most likely to experience an SR to either OROS-MPH or LDX therapies.

METHODS: A retrospective cohort study was conducted using Texas Medicaid claims data of ADHD children and adolescents (6 to 17 years of age) initiating OROS-MPH or LDX. Primary SR endpoints were drug discontinuation, switching, and augmentation 12-months post ADHD drug initiation. Logistic regression models were developed to predict SR to OROS-MPH and LDX in 1:1 matched groups of children and adolescent cohorts.

RESULTS: A total of 3,633 children and 1,611 adolescents were matched for each cohort. SR was observed among more children (76.4% vs. 72.3%; p < 0.001) and adolescents (82.7% vs. 78.2%; p = 0.002) initiating OROS-MPH compared to LDX. Patient subgroups with the highest predicted risk of OROS-MPH SR experienced significantly lower observed SR rates (p < 0.05) when initiating LDX (children: 80.6% for OROS-MPH vs. 75.8% for LDX; OR =0.75, 95% CI: 0.60-0.94; adolescents: 87.2% for OROS-MPH vs. 80.6% for LDX; OR =0.61, 95%CI: 0.41-0.89). For patients with highest predicted SR rates to LDX, observed SR rates were not significantly different between patients initiating LDX or OROS-MPH.

CONCLUSIONS: This study demonstrated how a personalized medicine approach using administrative claims data can be used to identify subgroups of child and adolescent ADHD patients with different risks for suboptimal response with OROS-MPH or LDX in a Medicaid population.

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