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30 Sep 2020

Grimmsmann T, Himmel W. Eur J Clin Pharmacol 2020; Epub ahead of print

In recent years an upward trend in children, adolescents and adults taking ADHD medications has been observed throughout Europe. This observational study aimed to analyse whether trends in ADHD prescribing in Germany observed during the last few years have remained stable or shifted, with a special focus on and comparison between children, adolescents and adults.

Data were obtained from the IMS® Disease Analyzer database.* Data were collected for individuals with ≥1 recorded diagnosis of ADHD based on the International Classification of Diseases, 10th Revision, Clinical Modification ([ICD-10-CM]: F90 attention-deficit hyperactivity disorders) between 2008 and 2018. Data collected included physician specialism, individual’s age and sex, diagnosis based on ICD-10 codes (up to level 4), date of diagnosis and referrals. Prescription data collected included date of visit, product expressed as anatomical therapeutic chemical code, strength and pack size.

A total of 620 practices representing 437 primary care physicians, 92 paediatricians, 64 neurologists and 27 psychiatrists provided data from 77,504 individuals with a diagnosis of ADHD. Mean age was 18.9 years at time of first ADHD diagnosis and/or first ADHD drug prescription; 30.8% were female. Almost 38% of individuals received ≥1 prescription for an ADHD medication during the time period. An increase in the number of people receiving medication rose from 6613 in 2008 to 8969 in 2012 and then decreased to 7533 in 2018. The number of individuals aged ≤16 years receiving medication for ADHD fell from 6767 in 2011 to 4085 in 2018 while there was an increase from 839 in 2008 to 1791 in 2018 in individuals aged ≥17 and ≤24 years. In those aged ≥25 years, the number of individuals receiving medication increased from 364 in 2008 to 1657 in 2018. The quantity of medications, in terms of daily defined doses, increased from 1,037,210 in 2008 to 1,537,449 in 2018 across all age groups. In adults aged ≥25 years there was an increase in medications from 57,029 in 2008 to 350,656 in 2018. Methylphenidate was the most prescribed drug for ADHD followed by lisdexamfetamine and atomoxetine, however, methylphenidate prescriptions decreased from 92% to 81% for children/adolescents and from 98% to 91% in adults during the study period. In children and adolescents, lisdexamfetamine increased to 23% of prescriptions. On average individuals received a prescription for 22 months and those aged <12 years remained on treatment for 2 years or longer while adults received medication for a much shorter time. Approximately two-thirds had ≥1 other ICD-10-CM mental, behavioural or neurodevelopmental disorder. Younger individuals were more commonly diagnosed with developmental disorders (54%) such as speech and language disorders while adults were more likely to be diagnosed with mood disorders (33%).

A limitation of the study was that the data source only included information on medications that were prescribed, but there was no way to determine whether the prescriptions were filled. In addition, individuals could not be followed across practices, therefore, individuals who received prescriptions from more than one practice or changed practices during the study time periods may have been missed.

In summary, the overall prescription of medicines to treat ADHD in Germany remained stable over the last few years. More adults are being prescribed medications for ADHD indicating that physicians are more aware of adult ADHD and are treating the condition in this population.

Read more about ADHD drug prescriptions in Germany here

 

*The database contains anonymized data from office based physicians across various disciplines from 2498 practices in Germany (Rathmann et al, 2018).

Bachmann CJ, Philipsen A, Hoffmann F. ADHD in Germany: trends in diagnosis and pharmacotherapy. Dtsch Arztebl Int 2017; 114: 141-148.

Ehrhardt C, Boucherie Q, Pauly V, et al. Methylphenidate: gender trends in adult and pediatric populations over a 7 year period. Therapie 2017; 72: 635-641.

Grimmsmann T, Himmel W. The 10-year trend in drug prescriptions for attention-deficit/hyperactivity disorder (ADHD) in Germany. Eur J Clin Pharmacol 2020; Epub ahead of print.

Rathmann W, Bongaerts B, Carius H-J, et al. Basic characteristics and representativeness of the German Disease Analyzer database. Int J Clin Pharmacol Ther 2018; 56: 459-466.

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