TY - JOUR
T1 - Acceptability, equity, and feasibility of using antipsychotics in children and adolescents with autism spectrum disorder
T2 - a systematic review
AU - D’Alò, Gian Loreto
AU - De Crescenzo, Franco
AU - Amato, Laura
AU - Cruciani, Fabio
AU - Davoli, Marina
AU - Fulceri, Francesca
AU - Minozzi, Silvia
AU - Mitrova, Zuzana
AU - Morgano, Gian Paolo
AU - Nardocci, Franco
AU - Saulle, Rosella
AU - Schünemann, Holger Jens
AU - Scattoni, Maria Luisa
AU - Tancredi, Raffaella
AU - Massagli, Angelo
AU - Valeri, Giovanni
AU - Cappa, Corrado
AU - Buono, Serafino
AU - Arduino, Giuseppe Maurizio
AU - Zuddas, Alessandro
AU - Reali, Laura
AU - Molteni, Massimo
AU - Felici, Claudia
AU - Cordò, Concetta
AU - Venturini, Lorella
AU - Bellosio, Cristina
AU - Di Tommaso, Emanuela
AU - Biasci, Sandra
AU - Duff, Clelia M.
AU - Vecchi, Simona
AU - Basile, Michele
AU - on behalf of the ISACA guideline working group
N1 - Funding Information:
Members of ISACA guideline working group Collaborating author names from the ISACA guideline working group: Raffaella, Tancredi; Angelo, Massagli; Giovanni, Valeri; Corrado, Cappa; Serafino, Buono; Giuseppe Maurizio, Arduino; Alessandro, Zuddas; Laura, Reali; Massimo, Molteni; Claudia, Felici; Concetta, Cord?; Lorella, Venturini; Cristina, Bellosio; Emanuela, Di Tommaso; Sandra, Biasci; Clelia M, Duff; Simona, Vecchi; Michele, Basile.
Publisher Copyright:
© 2020, The Author(s).
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - Background: It is unclear whether the administration of antipsychotics to children and adolescents with autism spectrum disorders (ASD) is acceptable, equitable, and feasible. Methods: We performed a systematic review to support a multidisciplinary panel in formulating a recommendation on antipsychotics, for the development of the Italian national guidelines for the management of ASD. A comprehensive search strategy was performed to find data related to intervention acceptability, health equity, and implementation feasibility. We used quantitative data from randomized controlled trials to perform a meta-analysis assessing the acceptability and tolerability of antipsychotics, and we estimated the certainty of the effect according to the GRADE approach. We extracted data from systematic reviews, primary studies, and grey literature, and we assessed the risk of bias and methodological quality of the published studies. Results: Antipsychotics were acceptable (dropouts due to any cause: RR 0.61, 95% CI 0.48–0.78, moderate certainty of evidence) and well tolerated (dropouts due to adverse events: RR 0.99, 95% CI 0.55–1.79, low certainty of evidence) by children and adolescents with ASD. Parents and clinicians did not raise significant issues concerning acceptability. We did not find studies reporting evidence of reduced equity for antipsychotics in disadvantaged subgroups of children and adolescents with ASD. Workloads, cost barriers, and inadequate monitoring of metabolic adverse events were indirect evidence of concerns for feasibility. Conclusion: Antipsychotics in children and adolescents with ASD were likely acceptable and possibly feasible. We did not find evidence of concern for equity.
AB - Background: It is unclear whether the administration of antipsychotics to children and adolescents with autism spectrum disorders (ASD) is acceptable, equitable, and feasible. Methods: We performed a systematic review to support a multidisciplinary panel in formulating a recommendation on antipsychotics, for the development of the Italian national guidelines for the management of ASD. A comprehensive search strategy was performed to find data related to intervention acceptability, health equity, and implementation feasibility. We used quantitative data from randomized controlled trials to perform a meta-analysis assessing the acceptability and tolerability of antipsychotics, and we estimated the certainty of the effect according to the GRADE approach. We extracted data from systematic reviews, primary studies, and grey literature, and we assessed the risk of bias and methodological quality of the published studies. Results: Antipsychotics were acceptable (dropouts due to any cause: RR 0.61, 95% CI 0.48–0.78, moderate certainty of evidence) and well tolerated (dropouts due to adverse events: RR 0.99, 95% CI 0.55–1.79, low certainty of evidence) by children and adolescents with ASD. Parents and clinicians did not raise significant issues concerning acceptability. We did not find studies reporting evidence of reduced equity for antipsychotics in disadvantaged subgroups of children and adolescents with ASD. Workloads, cost barriers, and inadequate monitoring of metabolic adverse events were indirect evidence of concerns for feasibility. Conclusion: Antipsychotics in children and adolescents with ASD were likely acceptable and possibly feasible. We did not find evidence of concern for equity.
KW - Antipsychotic agents
KW - Autism Spectrum disorder
KW - GRADE approach
KW - Guideline
KW - Systematic review
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U2 - 10.1186/s12888-020-02956-8
DO - 10.1186/s12888-020-02956-8
M3 - Article
C2 - 33238921
AN - SCOPUS:85096536446
VL - 20
JO - BMC Psychiatry
JF - BMC Psychiatry
SN - 1471-244X
IS - 1
M1 - 561
ER -