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Article: Mortality associated with attention-deficit hyperactivity disorder (ADHD) drug treatment: A retrospective cohort study of children, adolescents and young adults using the general practice research database

TitleMortality associated with attention-deficit hyperactivity disorder (ADHD) drug treatment: A retrospective cohort study of children, adolescents and young adults using the general practice research database
Authors
Issue Date2009
PublisherAdis International Ltd. The Journal's web site is located at http://drugsafety.adisonline.com/
Citation
Drug Safety, 2009, v. 32 n. 11, p. 1089-1096 How to Cite?
AbstractBackground: Following reports of sudden death in patients taking medicationto treat attention-deficit hyperactivity disorder (ADHD), this study aimed to identify cases of death in patients prescribed stimulants and atomoxetine and to determine any association between these and sudden death. Method: The UK General Practice Research Database (GPRD) was used to identify patients aged 2-21 years from 1 January 1993 to 30 June 2006 with a prescription for methylphenidate, dexamfetamine or atomoxetine. Patients were followed from the date of first prescription until whichever came first: date of death, transferred-out date, age >21 years or end of the study period. Results: From a cohort of 18 637 patient-years, seven patients died. Cause of death was obtained for six of the patients. None were deemed to be cases of sudden death. Compared with a general population rate of sudden death in the literature, the worst-case scenario of one case of sudden death gave an incident rate ratio of 1.63 (95% CI 0.04, 9.71). Although it was not the primary outcome of the study, following reports of suicide in the cohort the standardized mortality ratio (SMR) of suicide was calculated. Due to differences in the definition of suicide used for children and adults, patients were categorized into two age groups: 11-14 years and 15-21 years. The SMR for suicide for patients aged 11-14 years was 161.91 (95% CI 19.61, 584.88). The SMR for suicide for patients aged 15-21 years was 1.84 (95% CI 0.05, 10.25). Conclusion: This study demonstrated no increase in the risk of sudden death associated with stimulants or atomoxetine. However, an increased risk of suicide was seen. Although we cannot exclude that the medications maycontribute to the increased risk of suicide, there are other factors such as depression and antisocial behaviour that frequently co-exist with ADHD, which can also predispose to teenage suicide. Clinicians should identify patients at increased risk of cardiovascular evens and identify those patients at increased risk of suicide, particularly males with co-morbid conditions, and monitor them appropriately. © 2009 Adis Data Information BV. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/171386
ISSN
2015 Impact Factor: 3.206
2015 SCImago Journal Rankings: 1.359
References

 

DC FieldValueLanguage
dc.contributor.authorMccarthy, Sen_US
dc.contributor.authorCranswick, Nen_US
dc.contributor.authorPotts, Len_US
dc.contributor.authorTaylor, Een_US
dc.contributor.authorWong, ICKen_US
dc.date.accessioned2012-10-30T06:13:47Z-
dc.date.available2012-10-30T06:13:47Z-
dc.date.issued2009en_US
dc.identifier.citationDrug Safety, 2009, v. 32 n. 11, p. 1089-1096en_US
dc.identifier.issn0114-5916en_US
dc.identifier.urihttp://hdl.handle.net/10722/171386-
dc.description.abstractBackground: Following reports of sudden death in patients taking medicationto treat attention-deficit hyperactivity disorder (ADHD), this study aimed to identify cases of death in patients prescribed stimulants and atomoxetine and to determine any association between these and sudden death. Method: The UK General Practice Research Database (GPRD) was used to identify patients aged 2-21 years from 1 January 1993 to 30 June 2006 with a prescription for methylphenidate, dexamfetamine or atomoxetine. Patients were followed from the date of first prescription until whichever came first: date of death, transferred-out date, age >21 years or end of the study period. Results: From a cohort of 18 637 patient-years, seven patients died. Cause of death was obtained for six of the patients. None were deemed to be cases of sudden death. Compared with a general population rate of sudden death in the literature, the worst-case scenario of one case of sudden death gave an incident rate ratio of 1.63 (95% CI 0.04, 9.71). Although it was not the primary outcome of the study, following reports of suicide in the cohort the standardized mortality ratio (SMR) of suicide was calculated. Due to differences in the definition of suicide used for children and adults, patients were categorized into two age groups: 11-14 years and 15-21 years. The SMR for suicide for patients aged 11-14 years was 161.91 (95% CI 19.61, 584.88). The SMR for suicide for patients aged 15-21 years was 1.84 (95% CI 0.05, 10.25). Conclusion: This study demonstrated no increase in the risk of sudden death associated with stimulants or atomoxetine. However, an increased risk of suicide was seen. Although we cannot exclude that the medications maycontribute to the increased risk of suicide, there are other factors such as depression and antisocial behaviour that frequently co-exist with ADHD, which can also predispose to teenage suicide. Clinicians should identify patients at increased risk of cardiovascular evens and identify those patients at increased risk of suicide, particularly males with co-morbid conditions, and monitor them appropriately. © 2009 Adis Data Information BV. All rights reserved.en_US
dc.languageengen_US
dc.publisherAdis International Ltd. The Journal's web site is located at http://drugsafety.adisonline.com/en_US
dc.relation.ispartofDrug Safetyen_US
dc.subject.meshAdolescenten_US
dc.subject.meshAdrenergic Uptake Inhibitors - Adverse Effects - Therapeutic Useen_US
dc.subject.meshAttention Deficit Disorder With Hyperactivity - Drug Therapy - Mortalityen_US
dc.subject.meshCause Of Deathen_US
dc.subject.meshCentral Nervous System Stimulants - Adverse Effects - Therapeutic Useen_US
dc.subject.meshChilden_US
dc.subject.meshChild, Preschoolen_US
dc.subject.meshCohort Studiesen_US
dc.subject.meshDatabases, Factualen_US
dc.subject.meshDeath, Sudden - Etiologyen_US
dc.subject.meshDextroamphetamine - Adverse Effects - Therapeutic Useen_US
dc.subject.meshFemaleen_US
dc.subject.meshGreat Britainen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMethylphenidate - Adverse Effects - Therapeutic Useen_US
dc.subject.meshPropylamines - Adverse Effects - Therapeutic Useen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshRisk Factorsen_US
dc.subject.meshSuicide - Statistics & Numerical Dataen_US
dc.subject.meshYoung Adulten_US
dc.titleMortality associated with attention-deficit hyperactivity disorder (ADHD) drug treatment: A retrospective cohort study of children, adolescents and young adults using the general practice research databaseen_US
dc.typeArticleen_US
dc.identifier.emailWong, ICK:wongick@hku.hken_US
dc.identifier.authorityWong, ICK=rp01480en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.2165/11317630-000000000-00000en_US
dc.identifier.pmid19810780-
dc.identifier.scopuseid_2-s2.0-70349976442en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-70349976442&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume32en_US
dc.identifier.issue11en_US
dc.identifier.spage1089en_US
dc.identifier.epage1096en_US
dc.publisher.placeNew Zealanden_US
dc.identifier.scopusauthoridMcCarthy, S=26323217800en_US
dc.identifier.scopusauthoridCranswick, N=6601977827en_US
dc.identifier.scopusauthoridPotts, L=26323388900en_US
dc.identifier.scopusauthoridTaylor, E=7403206584en_US
dc.identifier.scopusauthoridWong, ICK=7102513915en_US

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