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Stakeholder Insight: ADHD - Prescriber Attention Still Held by Short Acting Stimulant DrugsPublished by: Datamonitor Published: Sep. 21, 2004 - 241 Pages Table of ContentsTABLE OF CONTENTS CHAPTER 1 EXECUTIVE SUMMARY 3 Scope of the analysis 3 Datamonitor insight into the ADHD market 5 Key metrics 6 CHAPTER 2 INTRODUCTION AND SCOPE 16 Coverage of the Stakeholder Insight Survey 16 Epidemiology and diagnosis of ADHD 16 Referral patterns 16 Treatment of ADHD 17 Drug profiles 17 CHAPTER 3 COUNTRY TREATMENT TREES 18 US 18 Japan 22 France 26 Germany 29 Italy 32 Spain 35 UK 38 CHAPTER 4 EPIDEMIOLOGY & PATIENT SEGMENTATION 41 Key findings 41 Disease definition and classification 42 Etiology of ADHD 42 Structural abnormalities 42 Genetic predisposition 42 Neurotransmitter dysfunction 43 Diagnostic criteria of ADHD 43 Epidemiology of ADHD 45 Prevalence of ADHD 45 Age of onset of ADHD 48 Progression to adult ADHD 49 Key patient segments 51 Gender 51 Comorbidities 55 Mood disorders and depression 56 Anxiety disorders 58 Tic disorder and Tourette’s syndrome 60 Autistic and Asperger’s disorder 62 Oppositional defiant disorder and conduct disorder 62 Substance abuse 64 Learning disabilities 65 CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS 68 Key findings 68 Diagnostic guidelines 69 Summary of DSM-IV criteria for the diagnosis of ADHD 69 Summary of ICD-10 criteria for the diagnosis of HKD 70 ADHD diagnostic algorithm 70 Diagnostic complications 73 Hyperkinesis versus attention deficit hyperactivity disorder 73 Gender 74 Age 74 Duration of symptoms 75 Diagnostic tools 75 ADHD Rating Scale 75 Copeland symptom checklist 75 Barkley’s Current Symptoms Scale-Self Report Form (home and school) 75 Brown ADD Scale (diagnostic form) 76 Parent-completed Child Behavior Checklist 76 Teacher Report Form (TRF) of Child Behavior Checklist 76 ADD-H: Comprehensive Teacher Rating Scale (ACTeRS) 77 Frequency of diagnostic tool usage 77 Diagnosis rates 79 Time to diagnosis 82 Diagnostic unmet needs 84 Referral patterns 87 Direct consultations 87 Referral patterns of interviewed physicians 89 Types of medical professional referred to 91 Treatment planning 94 Treatment guidelines 94 AAP guidelines 95 The Texas Children's Medication Algorithm 97 UK NICE guidelines 98 Pharmacological treatments 99 Stimulants 99 Amphetamines 102 Adderall and Adderall XR 102 Dextroamphetamines 103 Dexedrine and Dexedrine SR/Spansule 103 Dextrostat 103 Methylphenidate 104 Ritalin 104 Focalin 105 Metadate 106 Methylin 107 Concerta 107 Cylert 108 Non-stimulants 109 Strattera 109 Drugs prescribed off label 110 Antidepressants 110 a2-agonists 112 Antipsychotics 112 Non-pharmacological therapy 113 Economic consequences 114 CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS 116 Key findings 116 Introduction 117 Prescribing trends 117 Pharmacological versus non-pharmacological therapy 117 First-line treatment strategies 120 Drug classes prescribed in first-line therapy 122 Drugs prescribed in first-line therapy 124 Children 124 Adolescents 126 Immediate- versus modified-release drugs 127 Country-specific first-line therapy 129 US 130 Japan 131 Progression to second-line therapy 131 Second-line treatment strategies 134 Drug classes prescribed in second-line therapy 136 Second-line add-on strategies 137 Immediate- versus modified-release drugs in add-on therapy 139 Drugs used in second-line add-on therapy 140 Second-line switch strategies 142 Immediate- versus modified-release drugs in switch therapy 144 Drugs used in second-line switch therapy 145 US 147 Japan 148 Europe 148 Factors influencing physician decision making 149 Drug attributes 149 Parent and patient influence 151 Product profiles 152 CHAPTER 7 IMPROVING TREATMENT OUTCOMES 156 Key findings 156 Unmet needs of ADHD 157 Longer-acting therapies 157 How to improve the perceived efficacy and uptake of longer-acting therapies 158 Zinc 159 Immediate- and modified-release combinations 161 Pharmacokinetics 163 Novel formulations 164 Advocacy initiatives 169 National ADHD Awareness Day 169 New product development 171 Methypatch (transdermal methylphenidate) 172 Focalin LA (dexmethylphenidate) 173 SPD-503 175 Provigil (modafinil) 176 ABT-089 178 NS-2359 178 Recently discontinued drugs 179 SPD473 179 CHAPTER 8 OPINION LEADER TRANSCRIPTS 180 KOL 1 180 KOL 2 189 APPENDIX A 201 Bibliography 201 Websites 207 APPENDIX B 209 Physician sample breakdown 209 Physician research methodology 213 Contributing experts 213 APPENDIX C 214 Physician questionnaire 214 Report methodology 235 Date of research completion 235 About Datamonitor 235 About Datamonitor Healthcare 235 Datamonitor Healthcare’s research and analysis methodologies 236 Datamonitor Healthcare’s therapy area capabilities 236 About the CNS analysis team 237 Datamonitor Healthcare’s Consulting expertise 238 Datamonitor’s Therapeutic Consulting expertise 239 Key therapy team members 239 Lynda Lynch, Director CNS 239 David Abramson, Therapeutic Lead Consultant 240 Disclaimer 241 AbstractIntroductionDespite the plethora of once-daily drugs available for the treatment of ADHD, physicians consistently prescribe immediate release formulations. To bolster revenues, manufacturers must continue to promote awareness of ADHD at all levels, but most also seek to further differentiate their once-daily products from generics and other branded products in the eyes of both the patient and the physician. Scope Analysis is based on a survey of 180 prescribing physicians in the seven major markets as well as in-depth interviews with ADHD Key Opinion Leaders Detailed treatment trees showing the prevalence, diagnosis and treatment rates of ADHD across the seven major markets Analyzes the first and second-line treatment of children and adolescents with ADHD Identifies diagnostic and therapeutic unmet needs, highlights how manufacturers can drive patient identification as well as bolster drug prescriptions Highlights Datamonitor primary research has identified variances in class- and brand-prescribing preferences among physicians, although prescribing trends generally follow recognized national and international guidelines. However, there is concern over the use of combination therapies in the absence of conclusive clinical trial data. Only 12.3% of patients are diagnosed, indicating that a huge proportion of patients remain undiagnosed and untreated. Although the awareness of ADHD is ever growing, there are still significant gaps between, knowledge, recognition and referral of the disease. Datamonitor has highlighted these and provides counteractive strategic recommendations. Only 20% of patients receive longer-acting, once-daily drugs at first-line, falling to 3% at second-line, with physicians preferring immediate-release formulations. Consequently, Datamonitor has identified numerous lifecycle strategies to bolster long-acting drug sales. Reasons to Purchase Identify commercial opportunities by benchmarking current products and assessing unmet needs and future market potential Assess the size of the drug-treated population through an understanding of the prevalence of ADHD with comorbid psychiatric and behavioral disorders Communicate with physicians more effectively, through an understanding of prescribing behavior Get Full Details About This Report >> |
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