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Mental health
Risperidone and aripiprazole for autism spectrum disorder in children: an overview of systematic reviews
  1. Cecilia Fieiras1,
  2. Michael Hao Chen2,
  3. Camila Micaela Escobar Liquitay3,
  4. Nicolás Meza4,
  5. Valeria Rojas5,6,
  6. Juan Victor Ariel Franco7,
  7. Eva Madrid4
  1. 1School of Medicine, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  2. 2Minerva University, San Francisco, California, USA
  3. 3Central Library, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  4. 4Interdisciplinary Centre for Health Studies (CIESAL) - Cochrane Chile Associate Centre, Universidad de Valparaíso, Viña del Mar, Chile
  5. 5School of Medicine, Universidad de Valparaíso, Viña del Mar, Chile
  6. 6Autism program, Hospital Gustavo Fricke, Viña del Mar, Chile
  7. 7Associate Cochrane Centre-Research Department, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  1. Correspondence to Dr Juan Victor Ariel Franco, Associate Cochrane Centre-Research Department, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina; juanfranco{at}bmj.com

Abstract

Objectives To assess the effectiveness and safety of risperidone and aripiprazole in children with autism spectrum disorder (ASD).

Design and setting Overview of systematic reviews (SRs).

Search methods In October 2021, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycInfo and Epistemonikos placing no restrictions on language or date of publication.

Participants Children aged 12 years or less with ASD.

Interventions Risperidone and aripiprazole with no dosage restrictions.

Data collection and analysis We rated the methodological quality of the included SRs using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We reported the Grading of Recommendations, Assessment, Development and Evaluation certainty of the evidence according to the analysis conducted by the authors of the included SRs.

Main outcomes measured A multidisciplinary group of experts agreed on analysing nine critical outcomes evolving core and non-core ASD symptoms.

Patient and public involvement Organisations of parents of children with ASD were involved during part of the process, participating in external revision of the final version of the report for the Chilean Ministry of Health with no additional comments (ID 757-22-L120 DIPRECE, Ministry of Health, Chile). The organisations involved were: Fundación Unión Autismo y Neurodiversidad, Federación Nacional de Autismo, Vocería Autismo del Sur, and Vocería Autismo del Norte.

Results We identified 22 SRs within the scope of this overview, of which 16 were of critically low confidence according to AMSTAR 2 and were excluded from the analysis. Both aripiprazole and risperidone were effective for reducing autism symptoms severity, repetitive behaviours, inappropriate language, social withdrawal and behavioural problems compared with placebo. The certainty of the evidence for most outcomes was moderate. Risperidone and aripiprazole are associated with metabolic and neurological adverse events. Follow-up was short termed.

Conclusions We found that aripiprazole and risperidone probably reduce symptom severity at short-term follow-up but may also cause adverse events. High-quality and updated SRs and larger randomised controlled trials with longer term follow-up are needed on this topic.

Overview protocol PROSPERO CRD42020206535.

  • paediatrics
  • prescription drugs
  • nervous system diseases

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author on reasonable request and at our OSF registry (https://osf.io/aedxj/).

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Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author on reasonable request and at our OSF registry (https://osf.io/aedxj/).

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Footnotes

  • Twitter @micaelaescb, @nicolasmezac

  • Contributors All authors have contributed significantly to this manuscript and agree with its content. Study concept and design—JVAF, EM, NM, VR and CME-L. Acquisition of data—CME-L, NM and EM. Analysis/interpretation of data—all authors. Drafting of the article—CF, MC, NM, JVAF and CME-L. Revision of article—all authors. JVAF will be the guarantor of the study.

  • Funding In an effort to address the sizeable needs of this neglected population group, the Chilean Ministry of Health (MINSAL) commissioned a group of researchers from Universidad de Valparaíso to prepare a manual for a comprehensive approach to autism spectrum in children up to the age of 12 years, based on an investigation of SR that included pharmacological and/or non-pharmacological therapies available in our country. Department of Mental Health, Chilean Ministry of Health, Grant ID 757-22-L120.

  • Competing interests None declared.

  • Patient and public involvement statement Patients or the public were involved in the design, or conduct, or reporting, or dissemination plans of our research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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