Citation

Kreider AR, Matone M, Bellonci C, Dosreis S, Feudtner C, Huang YS, Rubin DM. J. Am. Acad. Child Adolesc. Psychiatry 2014; 53(9): 960-970.e2.

Copyright

(Copyright © 2014, American Academy of Child Adolescent Psychiatry, Publisher Lippincott Williams and Wilkins)

DOI

10.1016/j.jaac.2014.05.010

PMID

unavailable

Abstract

OBJECTIVE
Second-generation antipsychotics (SGAs) have increasingly been prescribed to Medicaid-enrolled children; however, there is limited understanding of the frequency of concurrent SGA prescribing with other psychotropic medications. This study describes the epidemiology of concurrent SGA use with four psychotropic classes (stimulants, antidepressants, mood stabilizers, alpha agonists) among a national sample of Medicaid-enrolled children aged 6-18 between 2004-2008.

METHOD
Repeated cross-sectional design was employed, using national Medicaid Analytic eXtract data (10.6 million children annually). Logit and Poisson regression standardized for year, demographics, and Medicaid eligibility group estimated the probability and duration of concurrent SGA use with each medication class over time and examined concurrent SGAs in relation to clinical and demographic characteristics.

RESULTS
While SGA use overall increased by 22%, 85% of such use occurred concurrently. By 2008, the probability of concurrent SGA use ranged from 0.22 for stimulant users to 0.52 for mood stabilizer users. Concurrent SGA use occurred for long durations (69-89% of annual medication days). Although the highest users of concurrent SGA were children in foster care and disability Medicaid programs or children with behavioral hospitalizations, the most significant increases over time occurred among children who were income-eligible for Medicaid (+13%), without comorbid ADHD (+15%), were not hospitalized (+13%), and without comorbid intellectual disability (+45%).

CONCLUSION
Concurrent SGA use with other psychotropic classes increased over time, and the duration of concurrent therapy was consistently long-term. Concurrent SGA regimens will require further research to determine efficacy and potential drug-drug interactions, given a practice trend toward more complex regimens in less-impaired children.