Basmah H Alfageh1,2, Zixuan Wang1, Pajaree Mongkhon1,3, Frank M C Besag1,4,5, Tariq M Alhawassi2,6, Ruth Brauer1, Ian C K Wong7,8. 1. School of Pharmacy, University College London, London, UK. 2. College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia. 3. School of Pharmaceutical Sciences, University of Phayao, Muang Phayao, Thailand. 4. East London Foundation NHS Trust, Bedfordshire, UK. 5. Maudsley Hospital and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 6. Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia. 7. School of Pharmacy, University College London, London, UK. wongick@hku.hk. 8. Department of Pharmacology and Pharmacy, University of Hong Kong, Pokfulam, Hong Kong. wongick@hku.hk.
Abstract
BACKGROUND: 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).
BACKGROUND: 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).
Authors: Mariken Dinnissen; Andrea Dietrich; Judith H van der Molen; Anne M Verhallen; Ynske Buiteveld; Suzanne Jongejan; Pieter W Troost; Jan K Buitelaar; Barbara J van den Hoofdakker; Pieter J Hoekstra Journal: J Clin Psychopharmacol Date: 2021 Jan/Feb 01 Impact factor: 3.118
Authors: Larissa Niemeyer; Konstantin Mechler; Ralf W Dittmann; Tobias Banaschewski; Jan Buitelaar; Sarah Durston; Alexander Häge Journal: Contemp Clin Trials Commun Date: 2022-08-14