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 4 psychotropic classes (stimulants, antidepressants, mood stabilizers, and α-agonists) among a national sample of Medicaid-enrolled children and adolescents 6 to 18 years old between 2004 and 2008.
Repeated cross-sectional design was used, with 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.
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 participants in foster care and disability Medicaid programs or those with behavioral hospitalizations, the most significant increases over time occurred among participants who were income-eligible for Medicaid (+13%), without comorbid ADHD (+15%), were not hospitalized (+13%), and did not have comorbid intellectual disability (+45%).
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/adolescents.
Key Words : second-generation antipsychotics, pediatric psychopharmacology, polypharmacy, Medicaid, foster care
| This article is discussed in an editorial by Dr. Mark Olfson, MD, MPH, on page xx.
| Supplemental material cited in this article is available online.
| An interview with the author is available by podcast at www.jaacap.org or by scanning the QR code to the right.
| This study was funded through AHRQ R01 HS01855001A1. Data for this study were made available through Centers for Medicare and Medicaid Services agreements 20927 and 23593.
| Dr. Localio served as the statistical expert for this research.
| Disclosure: Dr. Bellonci is president of the American Association of Children’s Residential Centers and a member of the Corporation of Walker, a multiservice agency in Needham, MA (volunteer, not a paid role). He has also been or continues to be a consultant for the Annie E. Casey Foundation, Casey Family Services, Center for Healthcare Strategies, Children’s Rights, and the US Department of Justice. Dr. Rubin, Ms. Kreider, and Ms. Matone are consultants for the Commonwealth of Pennsylvania on psychotropic medication use in the state’s Medicaid-enrolled children, funded by a grant from Casey Family Programs. Drs. dosReis, Feudtner, Localio, and Ms. Huang report no biomedical financial interests or potential conflicts of interest.