Polypharmacy, shifting prescriptions widespread for autism comorbidities | Spectrum
Pills picture: A wide range of drugs are used to treat the same co-occurring conditions as anxiety in people with autism.
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According to a new study, people with autism often switch medications to treat common co-occurring conditions like anxiety and attention deficit hyperactivity disorder (ADHD).
About 30 percent of autistic people take three or more psychotropic drugs at the same time to treat these comorbidities, the study shows – a percentage that is twice as high as a 2013 analysis.
“We were very surprised by the wide range and variety of drugs that are used to treat the same comorbidities and how often these have been changed in patients,” says Paul Avillach, Assistant Professor of Biomedical Informatics at Harvard Medical School. who directed the course.
American Academy of Pediatrics guidelines encourage physicians to use behavioral therapies to treat autistic children whenever possible. However, relatively few children with autism are receiving recommended behavioral therapies, and they are often taking drugs to treat comorbidities.
The new paper analyzes insurance claims and completed prescription records from a major health insurance company in the United States. It included data from around 27,000 people with autism who had been on the plan for at least a year and who were prescribed at least one drug for comorbidity. About 78 percent of the participants were male and the mean age was 14 years.
“You can’t hide from your bills,” says Avillach. “Every single time a patient took a drug and was reimbursed for the drug, this information was recorded.”
The study looked at 24 commonly prescribed drugs in three broad categories: those that treat arousal and irritation; those prescribed for hyperactivity and ADHD; and those for mood and anxiety disorders. Many people switched their medications from year to year, mostly within the same drug category, likely due to personal preference, side effects, or cost. The results appeared in JAMA Pediatrics in June.
The data are also subject to restrictions.
“If a parent changes jobs and switches to a different insurance company, we lack this data for their child,” says Avillach. “That’s why there are some holes.”
Almost half of the people in the dataset, 40.6 percent, had only one prescription in a given year, while 29.1 percent had two, 16.9 percent three, and 3.4 percent had five. In the period examined from January 2014 to December 2019, the number of people who took three or more drugs at the same time was between 28.6 and 31.5 percent.
The data also shows that there is little consistency in what clinicians prescribe to treat the same co-occurring conditions. For example, people with autism and anxiety were prescribed 16.1 percent aripiprazole, 30.1 percent quetiapine, and 13.1 percent risperidone.
Next, the team plans to narrow the scope, Avillach says. “We want to focus on specific comorbidities and examine the prescribing patterns more closely over time.”