Comorbidities in ADHD children treated with methylphenidate: a database study.
Comorbidities in ADHD children treated with methylphenidate: a database study.
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DOI：
10.1186/1471-244x-13-11
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发表时间：
2013-01-07
期刊：
影响因子：
4.4
通讯作者：
Garbe E
中科院分区：
文献类型：
--
作者：
Kraut AA;Langner I;Lindemann C;Banaschewski T;Petermann U;Petermann F;Mikolajczyk RT;Garbe E
哌醋甲酯 (MPH) 是治疗儿童注意力缺陷/多动障碍 (ADHD) 的最常见药物。如果存在某些精神、脑和心血管疾病，则禁止使用 MPH 治疗。我们评估了 MPH 新使用者的 MPH 治疗患病率和发生率，以及与这些禁忌症相关的合并症的频率，与没有 ADHD 和 ADHD 药物的对照组进行比较。我们使用了德国药物流行病学研究数据库 (GeParRD) 2004 年至 2006 年的医疗保健数据，该数据库包含约 18% 的德国人口。 MPH 治疗流行率和发生率是根据给定年份至少一种 MPH 处方进行评估的。在 MPH 使用者中，精神疾病和其他合并症的患病率在第一个 MPH 处方的季度和前三个季度进行评估，而在对照中，则在 2004 年 1 月 1 日开始的连续保险时间的最早四个季度或保险开始时间（如果较晚）进行评估。通过逻辑回归测试 MPH 用户和对照组之间共病诊断存在的差异。 2005 年，德国 1.5% 的 3 至 17 岁儿童和青少年（男性 2.3%，女性 0.6%）获得了 MPH。与对照组 (20%) 相比，新 MPH 用户 (83%) 中在九个 ICD 诊断类别中任何一个有精神科合并症记录的儿童比例要高得多。一般来说，脑和心血管合并症很少见。尽管如此，在新的 MPH 用户中，2% 的男性和女性被诊断患有既往心血管疾病，但对照组中这一比例仅为 1.2%。除了 MPH 治疗流行率之外，我们还首先发布了德国特定年龄的发病率。开始服用 MPH 的儿童中，很大一部分在第一次开处方之前有过精神科合并症的记录。在研究的年龄范围内，脑部和心血管疾病很少见，但接受 MPH 的儿童的发病率仍高于对照组。结果表明，在相当大的患者亚组中，合并症需要对 MPH 药物可能存在的风险与未经治疗的 ADHD 的风险进行彻底权衡。
Methylphenidate (MPH) is the most common drug treatment of attention deficit / hyperactivity disorder (ADHD) in children. Treatment with MPH is contraindicated in the presence of certain psychiatric, cerebro- and cardiovascular conditions. We assessed MPH treatment prevalence and incidence and the frequency of comorbid conditions related to these contraindications in new MPH users compared to a control group without ADHD and ADHD medication. We used health care data for the years 2004 to 2006 from the German Pharmacoepidemiological Research Database (GePaRD) which includes about 18% of the German population. MPH treatment prevalence and incidence was assessed based on at least one MPH prescription in the given year. In MPH users, the prevalence of psychiatric and other comorbidities was assessed in the quarter of the first MPH prescription and the three preceding quarters, whereas in controls it was assessed in the earliest four quarters of continuous insurance time starting at 01.01.2004 or the start of insurance if this was later. Differences in the presence of comorbid diagnoses between MPH users and controls were tested by logistic regression. In 2005, 1.5% of all children and adolescents aged 3 to 17 years (2.3% of males and 0.6% of females) received MPH in Germany. The proportion of children with a record of a psychiatric comorbidity in any of the nine ICD categories of diagnoses was substantially higher in new MPH users (83%) compared to controls (20%). Cerebro- and cardiovascular comorbidities were rare in general. Still, among new MPH users, 2% of males and females had a diagnosis of a pre-existing cardiovascular disorder but only 1.2% of controls. Besides MPH treatment prevalence we first publish age-specific incidence rates for Germany. A high proportion of children who were started on MPH had a record of a psychiatric comorbidity preceding the first prescription. Cerebro- and cardiovascular conditions were rare in the studied age range, but still higher among children who received MPH than in the control group. Results show that in a substantial subgroup of patients, comorbidities require a thorough weighting of possible risks of MPH medication against the risks of untreated ADHD.