TY - JOUR
T1 - Treatment with Methylphenidate for Attention Deficit Hyperactivity Disorder (ADHD) and the Risk of All-Cause Poisoning in Children and Adolescents
T2 - A Self-Controlled Case Series Study
AU - Gao, Le
AU - Man, Kenneth K.C.
AU - Chan, Esther W
AU - Chui, Celine S L
AU - Li, Xue
AU - Coghill, David
AU - Hon, Kam Lun
AU - Tse, Man Li
AU - Lum, Terry Y S
AU - Wong, Kirstie H T W
AU - Ip, Patrick
AU - Wong, Ian C K
N1 - Funding Information:
Le Gao, Kam Lun Hon, Man Li Tse, Terry Y.S. Lum, and Kirstie H.T.W. Wong declare no conflict of interest; Kenneth K.C. Man is the recipient of the CW Maplethorpe Fellowship, and reports grants from the National Institute for Health Research, UK, the Research Grant Council, Hong Kong, and personal fees from IQVIA Ltd., outside the submitted work; Esther W. Chan has received honorarium from the Hospital Authority, research grants from the Narcotics Division of the Security Bureau of HKSAR, National Health and Medical Research Council (NHMRC, Australia), National Natural Science Foundation of China (NSFC), Research Fund Secretariat of the Food and Health Bureau (HMRF, HKSAR), Research Grants Council (RGC, HKSAR), Wellcome Trust, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Janssen, Pfizer, RGA and Takeda, outside the submitted work; Celine S.L. Chui reports grants from Pfizer and personal fees from Primevigilance, outside the submitted work; Xue Li reports grants from Health and Medical Research Fund (HMRF), Janssen and an internal Seed Fund from the University of Hong Kong, outside the submitted work; David Coghill reports grants and personal fees from Shire/Takeda, personal fees from Medice, personal fees from Servier, personal fees from Oxford University Press, outside the submitted work; Patrick Ip reports research grants from the Hong Kong Research Grant Council (RGC) and Health and Medical Research Fund (HMRF), outside the submitted work; Ian C.K. Wong reports research funding outside the submitted work from Amgen, Bristol-Myers Squibb, Pfizer, Janssen, Bayer, GSK, Novartis, the Hong Kong RGC and the Hong Kong Health and Medical Research Fund, National Institute for Health Research in England, European Commission, National Health and Medical Research Council in Australia, and also received speaker fees from Janssen and Medice in the previous 3 years.
Funding Information:
This work was supported by Hong Kong Research Grants Council General Research Fund (No. 17125419) to Kenneth K.C. Man, Esther W. Chan, Celine S.L. Chui, David Coghill, Kam Lun Hon, Man Li Tse, Patrick Ip, and Ian C.K. Wong. The University of Hong Kong provided funding for open access.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/7/20
Y1 - 2021/7/20
N2 - BACKGROUND: Children and adolescents with attention deficit hyperactivity disorder (ADHD) are at higher risk of all-cause poisoning by drugs and chemicals (intentional or accidental). Currently, there is limited data on whether medication treatment for ADHD can reduce the risk of all-cause poisoning.METHODS: Patients aged 5-18 years with a methylphenidate (MPH) prescription and an incident poisoning diagnosis between January 2001 and June 2020 were identified from the Hong Kong Clinical Data Analysis and Reporting System. A self-controlled case series study design was used to compare the incidence rate ratios (IRRs) of all-cause poisoning during different risk windows (30 days before the first MPH prescription, exposure periods within 30 days of the first prescription, and periods of subsequent exposure) compared with the reference window (other non-exposure periods).RESULTS: 42,203 patients were prescribed ADHD medication in Hong Kong during the study period. Of these, 417 patients who had both an MPH prescription and poisoning incident recorded were included in the main analysis. Compared with other non-exposed periods, a higher risk of poisoning was found in the 30 days before the first prescription (IRR 2.64, 95% confidence interval [CI] 1.33-5.22) and exposure periods within 30 days of the first prescription (IRR 2.18, 95% CI 1.06-4.48), but not during prolonged exposure. However, compared with 30 days before the first prescription as well as exposure periods within 30 days of the first prescription, there was a lower risk during the subsequent exposure (IRRs 0.49 and 0.60, respectively). Similar results to the main analysis were also found in the subgroup analysis of intentional poisoning and females, but not in that of accidental poisoning and males.CONCLUSIONS: The risk of all-cause poisoning was higher shortly before and after the first MPH prescription and became lower during the subsequent prescription period. Our results do not support an association between the use of MPH and an increased risk of all-cause poisoning in children and adolescents and, in fact, suggest that longer-term use of MPH may be associated with a lower risk of all-cause poisoning, although this latter finding requires further study.
AB - BACKGROUND: Children and adolescents with attention deficit hyperactivity disorder (ADHD) are at higher risk of all-cause poisoning by drugs and chemicals (intentional or accidental). Currently, there is limited data on whether medication treatment for ADHD can reduce the risk of all-cause poisoning.METHODS: Patients aged 5-18 years with a methylphenidate (MPH) prescription and an incident poisoning diagnosis between January 2001 and June 2020 were identified from the Hong Kong Clinical Data Analysis and Reporting System. A self-controlled case series study design was used to compare the incidence rate ratios (IRRs) of all-cause poisoning during different risk windows (30 days before the first MPH prescription, exposure periods within 30 days of the first prescription, and periods of subsequent exposure) compared with the reference window (other non-exposure periods).RESULTS: 42,203 patients were prescribed ADHD medication in Hong Kong during the study period. Of these, 417 patients who had both an MPH prescription and poisoning incident recorded were included in the main analysis. Compared with other non-exposed periods, a higher risk of poisoning was found in the 30 days before the first prescription (IRR 2.64, 95% confidence interval [CI] 1.33-5.22) and exposure periods within 30 days of the first prescription (IRR 2.18, 95% CI 1.06-4.48), but not during prolonged exposure. However, compared with 30 days before the first prescription as well as exposure periods within 30 days of the first prescription, there was a lower risk during the subsequent exposure (IRRs 0.49 and 0.60, respectively). Similar results to the main analysis were also found in the subgroup analysis of intentional poisoning and females, but not in that of accidental poisoning and males.CONCLUSIONS: The risk of all-cause poisoning was higher shortly before and after the first MPH prescription and became lower during the subsequent prescription period. Our results do not support an association between the use of MPH and an increased risk of all-cause poisoning in children and adolescents and, in fact, suggest that longer-term use of MPH may be associated with a lower risk of all-cause poisoning, although this latter finding requires further study.
UR - http://www.scopus.com/inward/record.url?scp=85110879643&partnerID=8YFLogxK
U2 - 10.1007/s40263-021-00824-x
DO - 10.1007/s40263-021-00824-x
M3 - Article
C2 - 34283391
SN - 1172-7047
VL - 35
SP - 769
EP - 779
JO - CNS Drugs
JF - CNS Drugs
IS - 7
ER -
