Real-World Dose Titration Patterns Across Age Groups in Patients Treated With Delayed-Release/Extended-Release...

Delayed-release/extended-release methylphenidate (DR/ER-MPH) (JORNAY PM®; formerly HLD 200) is the first evening-dosed formulation of MPH approved for individuals ≥6 years with attention-deficit/hyperactivity disorder (ADHD). Designed for colonic absorption, DR/ER-MPH is expected to provide symptom control upon awakening, throughout the day, and into the evening. While clinical trials have established its efficacy in children aged 6-12 years, less is known about how this medication is titrated and maintained in real-world practice, particularly among adolescents and adults. This study aimed to characterize real-world titration and maintenance dosing patterns of DR/ER-MPH across age groups.

This retrospective observational study analyzed prescribing patterns using linked IQVIA's U.S. professional fee claims and prescription claims databases. Patients aged ≥4 years who initiated DR/ER-MPH between July 2019 and August 2022 were included if they had at least 6 months of baseline data and 12 months of follow-up. Dosing trends were evaluated for each prescription fill among patients with at least four prescription fills and the maintenance dose was defined as two consecutive prescriptions of the same dose. Analyses were descriptive in nature.

Among 2,831 eligible patients (mean age: 18.3 years; 58% male), the average titrating dose at initiation was 33.2 mg, with 60% of patients initiating treatment at 20 mg. By the fourth prescription, the average titrating dose increased to 49.4 mg, reflecting gradual upward titration over time. Maintenance dose, was achieved by 99% of patients, with higher average maintenance doses in adults (61.4 mg) compared to children and adolescents (51.8 mg).

Findings from this study highlight real-world titration patterns that differ from those observed in clinical trials, with more conservative up-titration and stabilization at lower doses. Importantly, this is the first large-scale analysis to include adult patients, expanding the evidence base for DR/ER-MPH use across age groups. Further research is warranted to assess how these real-world dosing patterns influence treatment outcomes and functional improvement in patients with ADHD.