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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

SO061

Effects of sustained ADHD pharmacotherapy on real-world outcomes: a target trial emulation study

EFFECTS OF SUSTAINED ADHD PHARMACOTHERAPY AFTER TWO YEARS: A NATIONWIDE TARGET TRIAL EMULATION STUDY

Among individuals who have taken ADHD medication continuously for at least one year, continuing treatment is associated with a lower risk of substance use disorder, suicide, crime, and all-cause mortality over two years of follow-up.

The study examines the effects of continuing versus discontinuing treatment on substance use disorder, suicide, accidental injury, traffic accidents, crime, and all-cause mortality among individuals aged 6 to 64 years who have received continuous ADHD pharmacotherapy for at least one year. New users of ADHD medication between 2005 and 2024 were identified in Swedish national registry data, and the final analytical cohort comprised 178,989 individuals who met the criterion of at least one year of continuous use. Within a target trial emulation framework, a new sequential emulated trial was initiated every 60 days after the first year of treatment (1 to 37 trials per person). Treatment continuation and discontinuation strategies were distinguished using definitions of a 60-day medication-free gap and a 60-day grace period, with follow-up for up to two years from entry into each trial; the analysis used a clone–censor–weight approach, inverse probability of censoring weighting (IPCW), and weighted pooled logistic regression. The weighted two-year risks for continuation and discontinuation, respectively, were 5.29% and 7.69% for substance use disorder (weighted OR 0.68; 95% CI 0.65 to 0.71), 1.71% and 2.30% for suicide (OR 0.74; 95% CI 0.68 to 0.80), and 13.78% and 14.03% for accidental injury (OR 0.98; 95% CI 0.95 to 1.01). The risks were 2.46% and 2.75% for traffic accidents (OR 0.89; 95% CI 0.83 to 0.96), 6.78% and 10.63% for crime (OR 0.62; 95% CI 0.60 to 0.65), and 0.25% and 0.47% for all-cause mortality (OR 0.53; 95% CI 0.43 to 0.64). Benefits persisted at ages 18 to 19, when the treatment discontinuation rate peaked; the weighted OR was 0.48 for crime (95% CI 0.42 to 0.55), 0.69 for substance use disorder (95% CI 0.61 to 0.78), and 0.86 for accidental injury (95% CI 0.78 to 0.94), whereas no significant differences were found for suicide (OR 0.88; 95% CI 0.72 to 1.08), traffic accidents (OR 0.93; 95% CI 0.76 to 1.14), or all-cause mortality (OR 0.99; 95% CI 0.39 to 2.48). Continuing treatment after sustained use is associated with lower two-year risks across multiple real-world outcomes, including during the transition period characterized by high discontinuation rates. Note: the abstract in the conference system reports an age range of 12 to 24 years, two years of continuous use, and a sample of 23,092 individuals; the updated data in the poster were used here.

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