Atypical antipsychotics for autism spectrum disorder: a network meta-analysis

Area of Science:

• Neuroscience and Psychiatry
• Clinical Pharmacology
• Developmental Psychology

Background:

• Autism spectrum disorder (ASD) presents diverse social and behavioral challenges.
• Atypical antipsychotics are frequently used for ASD symptoms like irritability and aggression.
• The comparative efficacy and safety of these medications remain unclear.

Purpose of the Study:

• To conduct a network meta-analysis on the comparative benefits of atypical antipsychotics for irritability in ASD.
• To assess benefits and harms of these drugs for various ASD symptoms and side effects versus placebo or other antipsychotics.
• To evaluate short-, medium-, and long-term outcomes in both children and adults with ASD.

Main Methods:

• Systematic search of multiple databases and trial registers.
• Inclusion of randomized controlled trials (RCTs) comparing atypical antipsychotics with placebo or other atypical antipsychotics in ASD.
• Network meta-analysis for irritability and random-effects models for other outcomes, with GRADE certainty assessment.

Main Results:

• Risperidone and aripiprazole showed potential short-term benefits for irritability in children with ASD compared to placebo (low-certainty evidence).
• Lurasidone demonstrated little to no effect on irritability (moderate-certainty evidence).
• Evidence for other outcomes like aggression, weight gain, and extrapyramidal side effects was very uncertain due to risk of bias and imprecision; some low-certainty evidence suggested benefits for obsessive-compulsive behaviors and inappropriate speech.

Conclusions:

• Risperidone and aripiprazole may help reduce irritability in children with ASD short-term.
• Evidence for other benefits and harms is limited and of low to very low certainty.
• Further high-quality RCTs, especially in adults, are needed with transparent reporting and consistent outcome measures.