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Randomised controlled trials of antipsychotics for people with autism spectrum disorder: a systematic review and a meta-analysis

Published online by Cambridge University Press:  04 August 2023

Shoumitro Deb Open the ORCID record for Shoumitro Deb [Opens in a new window] ,
Meera Roy ,
Bharati Limbu ,
Basma Akrout Brizard ,
Meena Murugan ,
Ashok Roy  and
Jacopo Santambrogio
Shoumitro Deb*
Affiliation:
Department of Brain Sciences, Faculty of Medicine, Imperial College London, 2nd Floor Commonwealth Building, Du Cane Road, London W12 0NN, UK
Meera Roy
Affiliation:
Hereford and Worcestershire Health and Care Trust, Kings Court, 2 Charles Hastings Way, WR5 1JR, UK
Bharati Limbu
Affiliation:
Department of Brain Sciences, Faculty of Medicine, Imperial College London, 2nd Floor Commonwealth Building, Du Cane Road, London W12 0NN, UK
Basma Akrout Brizard
Affiliation:
Université de Paris, Laboratory of Psychopathology and Health Processes, F-92100 Boulogne Billancourt, France
Meena Murugan
Affiliation:
Specialty Registrar in Psychiatry of Intellectual Disabilities, Coventry and Warwickshire Partnership NHS Foundation Trust, Brooklands Hospital, Coleshill Road, Birmingham, B37 7HL, UK
Ashok Roy
Affiliation:
Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
Jacopo Santambrogio
Affiliation:
Department of Medicine and Surgery, University Milano-Bicocca, Via della Misericordia 51, Vedano al Lambro (MB), 20854, Italy
*
Corresponding author: Shoumitro Deb; Email: s.deb@imperial.ac.uk
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Abstract

Background

Despite unclear evidence to support the long-term use of antipsychotics to treat challenging (problem) behaviours in people with autism in the absence of a psychiatric disorder, this practice is common.

Methods

We conducted a systematic review and meta-analysis of all randomised controlled trials (RCTs) involving antipsychotics for people with autism of all ages, irrespective of the outcomes assessed. We searched seven databases and hand-searched ten relevant journals. Two authors independently screened titles, abstracts and full papers and extracted data using the Cochrane Handbook template. We conducted meta-analyses of outcomes and the rate of adverse events.

Results

We included 39 papers based on 21 primary RCTs that recruited 1482 people with autism. No RCT assessed any psychiatric disorder outcome, such as psychoses or bipolar disorder. A meta-analysis of ten placebo-controlled RCTs showed a significantly improved Aberrant Behaviour Checklist-Irritability score in the antipsychotic group with an effect size of −6.45 [95% confidence interval (CI) −8.13 to −4.77] (low certainty). Pooled Clinical Global Impression data on 11 placebo-controlled RCTs showed an overall effect size of 0.84 (95% CI 0.48 to 1.21) (moderate certainty). There was a significantly higher risk of overall adverse effects (p = 0.003) and also weight gain (p < 0.00001), sedation (p < 0.00001) and increased appetite (p = 0.001) in the antipsychotic group.

Conclusions

There is some evidence for risperidone and preliminary evidence for aripiprazole to significantly improve scores on some outcome measures among children with autism but not adults or for any other antipsychotics. There is a definite increased risk of antipsychotic-related different adverse effects.

Keywords

Antipsychoticsautism spectrum disordermeta-analysisRCTssystematic review
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 16 , December 2023 , pp. 7964 - 7972
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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