Prescribing medications for attention-deficit/hyperactivity disorder in children: a retrospective analysis of a Japanese health insurance claims database

Background Despite pharmacotherapy being a significant treatment protocol for attention-deficit/hyperactivity disorder (ADHD), an increasingly common neurodevelopmental condition among children in Japan, prescribing practices for ADHD medications remain underexplored. This study examined prescribing patterns of medications for ADHD in children and adolescents aged 0–17 years in Japan and analyzed drug selection trends on the basis of patients’ backgrounds, including sex, age group, and medical department. Methods In this retrospective database study using a large Japanese health insurance claims database, we analyzed prescription patterns from April 2018 to August 2023. We examined the proportion of patients prescribed each of the four ADHD medications, namely, methylphenidate extended-release (OROS-MPH), atomoxetine (ATX), guanfacine (GXR), and lisdexamfetamine (LDX), their combination patterns, and new prescription proportions across different demographic groups and medical departments. The Jonckheere–Terpstra trend test was employed to assess trends in prescription proportions over time. The Mann‒Whitney U test was employed to compare time series data on the proportion of monotherapy prescriptions in psychiatric and nonpsychiatric settings. Results From 2018 to 2023, OROS-MPH prescriptions significantly decreased from 64.7% to 47.5%, whereas GXR prescriptions significantly increased from 19.3% to 46.4%. GXR was prescribed most frequently for female patients and children aged 6–12 years. For new patients, GXR prescriptions began exceeding those of OROS-MPH from late 2019 onward, comprising 41.3% of new prescriptions by 2023. The percentage of patients receiving monotherapy decreased from 82.3% to 79.6%, with OROS-MPH plus GXR being the most common combination therapy. Conclusions In Japan, GXR has become an increasingly preferred medication for ADHD, particularly for female patients and children aged 6–12 years, with new prescriptions exceeding those of OROS-MPH since late 2019. This trend may be attributed to GXR not being subject to the same distribution control regulations as central nervous system stimulants and to its distinctive pharmacological mechanisms that differ from those of other ADHD medications. Continuous monitoring of prescription practices is necessary as treatment options continue to evolve.