Safety and Tolerability of Antipsychotic Medication in Individuals with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

Alfageh, Basmah H.; Wang, Zixuan; Mongkhon, Pajaree; Besag, Frank; Alhawassi, Tariq M.; Brauer, Ruth; Wong, Ian C. K.

doi:10.1007/s40272-019-00333-x

Cited by 34 publications

(23 citation statements)

References 81 publications

(7 reference statements)

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“…Psychopharmacological treatment, especially antipsychotics, are used more frequently in subjects with ASD than in CHR-P (Sprong et al, 2008). In our review, the proportion of ASD treated with antipsychotics was somewhat higher, (19.0-50.0% vs 7.0-34.0%), compared to prior studies (Coury et al, 2012;Downs et al, 2016;Eussen et al, 2014;Murray et al, 2014) The increased use of antipsychotics may be related to its use in the treatment of behavioural symptoms in ASD (Alfageh et al, 2019;Owen et al, 2009;Shea et al, 2004). Moreover, a recent meta-analysis showed that there is little evidence to favour the use of antipsychotics to improve attenuated psychotic symptoms in CHR-P (Davies et al, 2018).…”

Section: Discussionmentioning

confidence: 53%

Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis

Vaquerizo‐Serrano

Pablo

Singh

et al. 2021

J Autism Dev Disord

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Psychotic experiences can occur in autism spectrum disorders (ASD). Some of the ASD individuals with these experiences may fulfil Clinical High-Risk for Psychosis (CHR-P) criteria. A systematic literature search was performed to review the information on ASD and CHR-P. A meta-analysis of the proportion of CHR-P in ASD was conducted. The systematic review included 13 studies. The mean age of ASD individuals across the included studies was 11.09 years. The Attenuated Psychosis Syndrome subgroup was the most frequently reported. Four studies were meta-analysed, showing that 11.6% of CHR-P individuals have an ASD diagnosis. Symptoms of prodromal psychosis may be present in individuals with ASD. The transition from CHR-P to psychosis is not affected by ASD.

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Section: Discussionmentioning

confidence: 53%

Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis

Vaquerizo‐Serrano

Pablo

Singh

et al. 2021

J Autism Dev Disord

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“…Parents reported the most frequent causes of drug discontinuation to be lack of efficacy and adverse events [48]. The higher rate of adverse events shown by recent meta-analyses [15,55] did not impact on discontinuation due to adverse events in our study. Moreover, according to a recent meta-analysis [60], antipsychotics had a reduced discontinuation due to lack of efficacy when compared against placebo.…”

Section: Discussioncontrasting

confidence: 44%

“…Parents could be reluctant to administer antipsychotics to their children, and concern towards adverse events often leads parents to shift towards complementary and alternative medicines [12,13]. Adverse events related to antipsychotics, such as increased appetite, weight gain, diabetes mellitus, and hyperlipidemia [14,15], may also discourage clinicians from prescribing them in children and adolescents with ASD. Adverse events can as well lead to treatment discontinuation and switch to other drugs.…”

Section: Introductionmentioning

confidence: 99%

Acceptability, equity, and feasibility of using antipsychotics in children and adolescents with autism spectrum disorder: a systematic review

D’Alò¹,

Crescenzo

Amato³

et al. 2020

BMC Psychiatry

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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.

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Section: Discussioncontrasting

confidence: 44%

“…Parents could be reluctant to administer antipsychotics to their children, and concern towards adverse events often leads parents to prefer complementary and alternative medicines [12,13]. Adverse events related to antipsychotics, such as increased appetite, weight gain, diabetes mellitus, and hyperlipidemia [14,15], may also discourage clinicians from prescribing them in children and adolescents with ASD. Adverse events can as well lead to treatment discontinuation and switch to other drugs.…”

Section: Introductionmentioning

confidence: 99%

Acceptability, equity, and feasibility of using antipsychotics in children and adolescents with autism spectrum disorder: a systematic review.

D’Alò

Crescenzo²,

Amato³

et al. 2020

Preprint

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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.

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Safety and Tolerability of Antipsychotic Medication in Individuals with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

Cited by 34 publications

References 81 publications

Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis

Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis

Acceptability, equity, and feasibility of using antipsychotics in children and adolescents with autism spectrum disorder: a systematic review

Acceptability, equity, and feasibility of using antipsychotics in children and adolescents with autism spectrum disorder: a systematic review.

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