Risperidone and aripiprazole for autism spectrum disorder in children: an overview of systematic reviews

Abstract

ObjectivesTo assess the effectiveness and safety of risperidone and aripiprazole in children with autism spectrum disorder (ASD).Design and settingOverview of systematic reviews (SRs).Search methodsIn October 2021, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycInfo and Epistemonikos placing no restrictions on language or date of publication.ParticipantsChildren aged 12 years or less with ASD.InterventionsRisperidone and aripiprazole with no dosage restrictions.Data collection and analysisWe 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 measuredA multidisciplinary group of experts agreed on analysing nine critical outcomes evolving core and non-core ASD symptoms.Patient and public involvementOrganisations 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.ResultsWe 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.ConclusionsWe 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 protocolPROSPERO CRD42020206535.