Real-World Analysis Comparing Persistence and Adherence of Delayed-Release/Extended-Release Methylphenidate with...

The effectiveness of extended release (ER) stimulant medication to treat attention-deficit/hyperactivity disorder (ADHD) is often hindered due to low medication adherence and discontinuation. Several factors such as differences in medication formulations, age, and dosing convenience reduce persistence to treatment. This retrospective database review of real-world evidence aims to compare the persistence and adherence among patients with ADHD initiating different ER stimulant treatments, including delayed-release/extended-release methylphenidate (DR/ER-MPH).

A retrospective, observational study was conducted using linked data from IQVIA open-source prescription claims (LRx) and medical claims (Dx) databases. Patients aged ≥4 years with at least one prescription claim for DR/ER-MPH, branded ER amphetamine (AMP), generic ER AMP, branded ER MPH, or generic ER MPH between July 1, 2019, and August 31, 2022, were included. Persistence, defined as continuous use of the index medication without a gap equal to or greater than the duration of the last prescription, was calculated among all patients and for subgroups by age. Adherence was measured using the proportion of days covered (PDC) over the 12-month post-index treatment period. Comparisons were made between DR/ER-MPH and other treatment groups. Multivariate logistic regression models were developed to identify factors associated with persistence and adherence.

A total of 1,847,004 patients were identified, including 585,535 children and adolescents (6-17 years) and 1,245,223 adults (≥18 years). The overall 12-month persistence was highest in the generic ER AMP cohort (30.4%). The DR/ER-MPH cohort showed significantly higher persistence (24.4%) compared with MPH cohorts (branded ER MPH: 16.5%, generic ER MPH: 20.6%) and branded ER AMP cohort (22.8%). Among persistent patients, adherence was higher in the DR/ER-MPH cohort (85.5%) compared with branded ER MPH (74.6%) and generic ER MPH (78.7%) but lower compared with generic ER AMP (88.2%). In children and adolescents, DR/ER-MPH found the highest 12-month persistence among all treatment cohorts (28.2%). Drug holidays were more common among children and adolescents, with the highest proportion in branded ER MPH patients (18.7%), though DR/ER-MPH patients had fewer drug holidays than both branded and generic ER MPH. Factors such as age, gender, and formulation type affected persistence and adherence among these patients.

In the real-world clinical practice, DR/ER-MPH found higher persistence and adherence compared with other ER MPH formulations, particularly among children. However, persistence was similar or lower compared with AMP formulations. These findings highlight the importance of personalized ADHD pharmacotherapy, considering factors such as age, gender, and medication characteristics to optimize long-term outcomes.