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

TitleSafety and Tolerability of Antipsychotic Medication in Individuals with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis
Authors
Keywordsadverse drug reaction
akathisia
autism
automutilation
constipation
Issue Date2019
PublisherAdis International Ltd. The Journal's web site is located at http://www.springer.com/adis/journal/40272
Citation
Pediatric Drugs, 2019, v. 21 n. 3, p. 153-167 How to Cite?
AbstractBackground: Antipsychotic medication is a commonly prescribed drug class in individuals with autism spectrum disorder (ASD). However, the safety of these agents has not been fully assessed. Objective: Our objective was to investigate the safety and tolerability profile of antipsychotics in individuals with ASD. Methods: The Cochrane Library, MEDLINE, Embase and PsycINFO databases were searched up to January 2018. We included studies that reported adverse events (AEs) in participants with ASD taking first- or second-generation antipsychotic medication. The studies included in the analysis were randomized controlled trials (RCTs) and observational studies that were comparative or noncomparative and published as full text in the English language. The primary outcome of this review was AEs of any severity reported with antipsychotic use at any dose. Meta-analysis was performed on studies with child and adolescent participants to estimate the pooled prevalence of the overall AEs and the relative risk (RR) of AEs associated with antipsychotic use using a random-effects model. The Cochrane Collaboration tool and the modified Newcastle–Ottawa Scale (NOS) were used to assess the risk of bias of the included RCTs and observational studies, respectively. Results: In total, 54 citations fulfilled the inclusion criteria, of which 40 were RCTs and 14 were observational studies; eight RCTs were included in the meta-analysis to estimate the RR of AEs associated with antipsychotic use and seven observational studies were included to estimate the pooled prevalence of AEs. The RR of AEs with antipsychotic treatment was 22% higher than with placebo (RR 1.22; 95% confidence interval [CI] 1.11–1.34; I2 = 30.6%; p = 0.184). The estimated pooled prevalence of AEs was 50.5% (95% CI 33–67). The most commonly reported AEs were increased appetite and weight gain, which were associated with discontinuation in many participants. Conclusion: Antipsychotic-related AEs were common among patients with ASD. Further studies to investigate the implications of antipsychotic-related AEs on health and medication adherence are warranted. PROSPERO registration number: (CRD42018083632)
Persistent Identifierhttp://hdl.handle.net/10722/278595
ISSN
2019 Impact Factor: 2.519
2015 SCImago Journal Rankings: 0.791

 

DC FieldValueLanguage
dc.contributor.authorAlfageh, BH-
dc.contributor.authorWang, Z-
dc.contributor.authorMongkhon, P-
dc.contributor.authorBesag, FMC-
dc.contributor.authorAlhawassi, TM-
dc.contributor.authorBrauer, R-
dc.contributor.authorWong, ICK-
dc.date.accessioned2019-10-21T02:10:26Z-
dc.date.available2019-10-21T02:10:26Z-
dc.date.issued2019-
dc.identifier.citationPediatric Drugs, 2019, v. 21 n. 3, p. 153-167-
dc.identifier.issn1174-5878-
dc.identifier.urihttp://hdl.handle.net/10722/278595-
dc.description.abstractBackground: Antipsychotic medication is a commonly prescribed drug class in individuals with autism spectrum disorder (ASD). However, the safety of these agents has not been fully assessed. Objective: Our objective was to investigate the safety and tolerability profile of antipsychotics in individuals with ASD. Methods: The Cochrane Library, MEDLINE, Embase and PsycINFO databases were searched up to January 2018. We included studies that reported adverse events (AEs) in participants with ASD taking first- or second-generation antipsychotic medication. The studies included in the analysis were randomized controlled trials (RCTs) and observational studies that were comparative or noncomparative and published as full text in the English language. The primary outcome of this review was AEs of any severity reported with antipsychotic use at any dose. Meta-analysis was performed on studies with child and adolescent participants to estimate the pooled prevalence of the overall AEs and the relative risk (RR) of AEs associated with antipsychotic use using a random-effects model. The Cochrane Collaboration tool and the modified Newcastle–Ottawa Scale (NOS) were used to assess the risk of bias of the included RCTs and observational studies, respectively. Results: In total, 54 citations fulfilled the inclusion criteria, of which 40 were RCTs and 14 were observational studies; eight RCTs were included in the meta-analysis to estimate the RR of AEs associated with antipsychotic use and seven observational studies were included to estimate the pooled prevalence of AEs. The RR of AEs with antipsychotic treatment was 22% higher than with placebo (RR 1.22; 95% confidence interval [CI] 1.11–1.34; I2 = 30.6%; p = 0.184). The estimated pooled prevalence of AEs was 50.5% (95% CI 33–67). The most commonly reported AEs were increased appetite and weight gain, which were associated with discontinuation in many participants. Conclusion: Antipsychotic-related AEs were common among patients with ASD. Further studies to investigate the implications of antipsychotic-related AEs on health and medication adherence are warranted. PROSPERO registration number: (CRD42018083632)-
dc.languageeng-
dc.publisherAdis International Ltd. The Journal's web site is located at http://www.springer.com/adis/journal/40272-
dc.relation.ispartofPediatric Drugs-
dc.rightsThe final publication is available at Springer via http://dx.doi.org/[insert DOI]-
dc.subjectadverse drug reaction-
dc.subjectakathisia-
dc.subjectautism-
dc.subjectautomutilation-
dc.subjectconstipation-
dc.titleSafety and Tolerability of Antipsychotic Medication in Individuals with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis-
dc.typeArticle-
dc.identifier.emailWong, ICK: wongick@hku.hk-
dc.identifier.authorityWong, ICK=rp01480-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1007/s40272-019-00333-x-
dc.identifier.pmid31134563-
dc.identifier.scopuseid_2-s2.0-85067887348-
dc.identifier.hkuros308238-
dc.identifier.volume21-
dc.identifier.issue3-
dc.identifier.spage153-
dc.identifier.epage167-
dc.publisher.placeNew Zealand-

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