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. 2019 Jul 15:9.
doi: 10.7916/tohm.v0.645. eCollection 2019.

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

Nicholas Cothros  1 , Davide Martino  1 , Carly McMorris  2   3 , David Stewart  4 , Ali Tehrani  4 , Tamara Pringsheim  1   5   6
Affiliations

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

Nicholas Cothros et al. Tremor Other Hyperkinet Mov (N Y). .

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.

Keywords: Tic disorders; Tourette syndrome; alpha agonists; antipsychotics; pharmacoepidemiology.

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Conflict of interest statement

Funding: None. Conflicts of Interest: The authors report no conflict of interest. David Stewart and Ali Tehrani are employees of IQVIA Canada. Ethics Statement: The data used for this study were drawn from IQVIA’s Canadian Disease and Therapeutic Index (CDTI). This is a proprietary source of data belonging to IQVIA and therefore not publicly available. IQVIA is a multinational company offering consultative and analytical services pertaining to their data products, focusing chiefly on clinical research and health information technologies. As noted in the Methods section, participating physicians completed an anonymised record of all patient visits during a 48-hour period in each quarter of the year. Informed consent was not required as no personal identifying information was collected. No institutional review board was required, as the research did not entail experimental investigation of human participants.

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