Utilization of psychotropic medications in individuals with autism spectrum disorder

Second-generation antipsychotics (SGAs), specifically aripiprazole and risperidone, and selective serotonin reuptake inhibitors (SSRIs), are psychotropic medications commonly prescribed to individuals with autism spectrum disorder (ASD). However, it is unclear how often individuals with ASD initiate with SGAs, how frequently they switch medications, and how utilization has changed over time. This study investigates trends in psychotropic medication use among individuals with ASD in the USA from 2012 to 2021.

We analyzed a national cohort of commercially insured individuals with ASD aged 2 to 26 years using data from the IQVIA PharMetrics Plus for Academics database. Individuals were classified as newly prescribed if they had not previously received a prescription for the medication before the study period, and no prescription in the period immediately preceding it. We examined trends in psychotropic medication utilization yearly and conducted a detailed month-by-month analysis for 2019. A Mann-Whitney U test was used to compare medication switching rates between SSRIs and SGAs.

Among 24,730 individuals, 64.6% were prescribed SGAs or SSRIs. Medication switching was more frequent among those initially prescribed aripiprazole or risperidone (6.13% annually) compared to those starting with SSRIs (3.41%). The Mann-Whitney U test (W = 67, p < 0.05) confirmed a significant difference in switching rates between the two groups. Switching from risperidone decreased from 2012 to 2021 (Spearman's ρ = -0.32), whereas switching from aripiprazole increased (Spearman's ρ = 0.50).

Individuals with ASD newly prescribed SGAs switched to other drug classes nearly twice as often as those prescribed SSRIs. The higher switching rate may be influenced by adverse effects or insufficient symptom improvement. Future studies should explore long-term outcomes and the clinical decision-making processes underlying medication changes.

Not applicable.