TY - JOUR
T1 - Impact of antipsychotics in children and adolescents with autism spectrum disorder
T2 - a systematic review and meta-analysis
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 - 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.
Publisher Copyright:
© 2021, The Author(s).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/12
Y1 - 2021/12
N2 - Background: The net health benefit of using antipsychotics in children and adolescents with ASD is unclear. This review was performed to provide the evidence necessary to inform the Italian national guidelines for the management of ASD. Methods: We performed a systematic review of randomized controlled trials (RCTs) comparing antipsychotics versus placebo for the treatment of ASD in children and adolescents. For efficacy, acceptability and safety we considered outcomes evaluated by the guideline panel critical and important for decision-making. Continuous outcomes were analyzed by using standardized mean difference (SMD), and dichotomous outcomes by calculating the risk ratio (RR), with their 95% confidence interval (95% CI). Data were analyzed using a random effects model. We used the Cochrane tool to assess risk of bias of included studies. Certainty in the evidence of effects was assessed according to the GRADE approach. Results: We included 21 RCTs with 1,309 participants, comparing antipsychotics to placebo. Antipsychotics were found effective on “restricted and repetitive interests and behaviors” (SMD − 0.21, 95% CI − 0.35 to − 0.07, moderate certainty), “hyperactivity, inattention, oppositional, disruptive behavior” (SMD − 0.67, 95% CI − 0.92 to − 0.42, moderate certainty), “social communication, social interaction” (SMD − 0.38, 95% CI − 0.59 to − 0.16, moderate certainty), “emotional dysregulation/irritability” (SMD − 0.71, 95% CI − 0.98 to − 0.43, low certainty), “global functioning, global improvement” (SMD − 0.64, 95% CI − 0.96 to − 0.33, low certainty), “obsessions, compulsions” (SMD − 0.30, 95% CI − 0.55 to − 0.06, moderate certainty). Antipsychotics were not effective on “self-harm” (SMD − 0.14, 95% CI − 0.58 to 0.30, very low certainty), “anxiety” (SMD − 0.38, 95% CI − 0.82 to 0.07, very low certainty). Antipsychotics were more acceptable in terms of dropout due to any cause (RR 0.61, 95% CI 0.48 to 0.78, moderate certainty), but were less safe in terms of patients experiencing adverse events (RR 1.19, 95% CI 1.07 to 1.32, moderate certainty), and serious adverse events (RR 1.07, 95% CI 0.48 to 2.43, low certainty). Conclusions: Our systematic review and meta-analysis found antipsychotics for children and adolescents with ASD more efficacious than placebo in reducing stereotypies, hyperactivity, irritability and obsessions, compulsions, and in increasing social communication and global functioning. Antipsychotics were also found to be more acceptable, but less safe than placebo.
AB - Background: The net health benefit of using antipsychotics in children and adolescents with ASD is unclear. This review was performed to provide the evidence necessary to inform the Italian national guidelines for the management of ASD. Methods: We performed a systematic review of randomized controlled trials (RCTs) comparing antipsychotics versus placebo for the treatment of ASD in children and adolescents. For efficacy, acceptability and safety we considered outcomes evaluated by the guideline panel critical and important for decision-making. Continuous outcomes were analyzed by using standardized mean difference (SMD), and dichotomous outcomes by calculating the risk ratio (RR), with their 95% confidence interval (95% CI). Data were analyzed using a random effects model. We used the Cochrane tool to assess risk of bias of included studies. Certainty in the evidence of effects was assessed according to the GRADE approach. Results: We included 21 RCTs with 1,309 participants, comparing antipsychotics to placebo. Antipsychotics were found effective on “restricted and repetitive interests and behaviors” (SMD − 0.21, 95% CI − 0.35 to − 0.07, moderate certainty), “hyperactivity, inattention, oppositional, disruptive behavior” (SMD − 0.67, 95% CI − 0.92 to − 0.42, moderate certainty), “social communication, social interaction” (SMD − 0.38, 95% CI − 0.59 to − 0.16, moderate certainty), “emotional dysregulation/irritability” (SMD − 0.71, 95% CI − 0.98 to − 0.43, low certainty), “global functioning, global improvement” (SMD − 0.64, 95% CI − 0.96 to − 0.33, low certainty), “obsessions, compulsions” (SMD − 0.30, 95% CI − 0.55 to − 0.06, moderate certainty). Antipsychotics were not effective on “self-harm” (SMD − 0.14, 95% CI − 0.58 to 0.30, very low certainty), “anxiety” (SMD − 0.38, 95% CI − 0.82 to 0.07, very low certainty). Antipsychotics were more acceptable in terms of dropout due to any cause (RR 0.61, 95% CI 0.48 to 0.78, moderate certainty), but were less safe in terms of patients experiencing adverse events (RR 1.19, 95% CI 1.07 to 1.32, moderate certainty), and serious adverse events (RR 1.07, 95% CI 0.48 to 2.43, low certainty). Conclusions: Our systematic review and meta-analysis found antipsychotics for children and adolescents with ASD more efficacious than placebo in reducing stereotypies, hyperactivity, irritability and obsessions, compulsions, and in increasing social communication and global functioning. Antipsychotics were also found to be more acceptable, but less safe than placebo.
KW - Adolescents
KW - Antipsychotics
KW - Autism spectrum disorder
KW - Children
KW - D2 blockers
KW - Guidelines
KW - Meta-analysis
KW - Systematic review
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U2 - 10.1186/s12955-021-01669-0
DO - 10.1186/s12955-021-01669-0
M3 - Article
AN - SCOPUS:85099927900
VL - 19
JO - Health and Quality of Life Outcomes
JF - Health and Quality of Life Outcomes
SN - 1477-7525
IS - 1
M1 - 33
ER -