Prescriptions for Alpha Agonists and Antipsychotics in Children and Youth with Tic Disorders: A Pharmacoepidemiologic Study

Nicholas Cothros,Davide Martino,Ali Tehrani,Carly Mcmorris,David Stewart,Tamara Pringsheim

doi:10.5334/tohm.459

Abstract

Background: Trends in the use of antipsychotics and alpha agonists for the treatment of tic disorders in Canadian children, and how closely these trends align with evidence-based guidelines on the pharmacotherapy of tic disorders, have not been explored. Methods: IQVIA’s Canadian Disease and Therapeutic Index, a survey-based data set, was used to identify prescription patterns by physicians. Respondents recorded all patient visits during a 48-hour period in each quarter of the year, including patient age, gender, drug recommendation and therapeutic indication. Recommendations for alpha agonists and antipsychotics from 2012 to 2016 were analysed for children and adolescents with tic disorders. Results: Risperidone and clonidine were the most commonly recommended medications for tic disorders over the study period, with 36,868 and 35,500 recommendations in 2016, respectively. Recommendations for clonidine increased over the study period, whereas those for risperidone decreased. Guanfacine (approved in Canada in 2013) was used less frequently than clonidine. Clonidine was more frequently recommended than antipsychotics in children younger than 6, in whom antipsychotic recommendations were uncommon. Aripiprazole was the second most commonly recommended antipsychotic for tic disorders, with 22,892 recommendations in 2016. Of the first-generation antipsychotics, pimozide was most commonly recommended (11,334 recommendations in 2016); haloperidol was infrequently recommended. Discussion: The trends observed are in line with guideline recommendations reflected in the decreasing use of risperidone, and the growing use of clonidine and guanfacine. The growing use of aripiprazole is likely due to emerging evidence from clinical trials supporting its efficacy for tics. Recommendations for pimozide and haloperidol were limited, likely due to the greater adverse effects associated with these medications.

Highlights

Tic disorders have been conceptualised as hyperkinetic movement disorders, manifesting as brief and intermittent movements or sounds, and further characterised by their highly repetitive nature and waxing-and-waning course.[1]
The most common cause of tics in childhood is Tourette syndrome (TS), which is characterised by both motor and phonic tics and is often accompanied by psychiatric comorbidities including attention deficit hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD)
Canadian Disease and Therapeutic Index (CDTI) is an ideal source for this type of study as compared to administrative prescription records, as the latter are typically collected in specific Canadian populations and prescribed certain drugs, often without information about indication or prescribing intent

Summary

Introduction

Tic disorders have been conceptualised as hyperkinetic movement disorders, manifesting as brief and intermittent movements (motor tics) or sounds (phonic tics), and further characterised by their highly repetitive nature and waxing-and-waning course.[1].

Results

Conclusion