(187) Continued Benefits of Pharmacological Treatment of ADHD on Unintentional Injuries: Emulation of a Target Trial with Swedish Real-World Data

Publication Number: 1232

Background: Pharmacological treatment of attention-deficit/hyperactivity disorder (ADHD) has been shown to reduce the risk of unintentional injuries among children, yet discontinuation of ADHD medications is quite common.

Objectives: We aim to examine if continuation of pharmacological treatment of ADHD after 2 years of use reduces the risk of unintentional injuries in children and adolescents.

Methods: Using linkage of from Swedish national registers, we identified children and adolescents aged 8–18 years who had been treated with ADHD medications for 2 years or longer during 2006-2013. We applied the target trial emulation approach on the basis of cloning, censoring, and weighting, and compared the risks of unintentional injuries after continuing ADHD medication versus stopping and remaining off ADHD medication. Hazard ratios (HRs) and cumulative incidence were estimated for unintentional injuries in one year after treatment discontinuation or continuation.

Results: We identified 19,835 individuals (median age 13 (IQR: 11-16) years, 77% boys) who had been treated with ADHD medication for at least 2 years. During the study period, 35.4% of individuals had at least one discontinuation with their ADHD medication treatment. Preliminary results showed that continuation of ADHD medications was associated with 9% reduced hazard of unintentional injuries (HR= 0.91, 95% confidence interval: 0.70 - 1.08) compared to treatment discontinuation in 1 year. Continuation of ADHD medications decreased the 1-year cumulative incidence of unintentional injuries by 0.78% compared to treatment discontinuation.

Conclusions: In this nationwide observational study of people treated with ADHD medications for 2 years or longer, continuation of pharmacological treatment of ADHD was associated with decreased risk of unintentional injuries.